VVMO    U/V-'l^AA  I  t 


Date 


THE  ROLLER  BANDAGE 


ROLLER  BANDAGE 


WILLIAM  BARTON  HOPKINS,  M.D. 

SURGEON    TO    PENNSYLVANIA    HOSPITAL    AND    TO    THJt 

ORTHOPEDIC    HOSPITAL    AND    INFIRMARY 

TOR   NERVOUS    DISEASES 


WITH     ILLUSTRATIONS 


SEVENTH  EDITION 


PHILADELPHIA 

J.  3.  LIPPINCOTT    COMPANY 

1912 


Copynght,  1883 
BY  J.  B.  LIPPINCOTT  &  Co. 

Copyright,  1897 
BY  J.  B.  LIPPINCOTT  COMPANY 

Copyright,  1902 
BY  J.  B.  LIPPINCOTT  COMPANY 

Copyright,  1911 
BY  CHAS.  B.  PENROSB  AND  J.  RODMAN  PAUL 


Electrotyped  and  Printed  by 
J.  B.  Lippincott  Company,  Philadelphia.  U.S.A. 


Preface  to  the  Fifth  Edition. 


As  general  proficiency  in  bandaging  and 
in  the  application  of  dressings  can  only  be 
obtained  by  acquiring  skill  in  the  handling  of 
the  roller  bandage,  the  use  of  the  latter  may 
well  be  regarded  as  the  basis  of  all  bandaging, 
for  it  possesses  principles  which  once  learned 
are  susceptible  of  modification  to  an  infinite 
variety  of  requirements.  The  title  of  this 
book,  therefore,  has  its  significance.  It  means 
more  than  a  mere  monograph  on  the  roller 
bandage,  for  the  book  is  intended  to  teach  the 
principles  of  bandaging  as  well. 

The  destruction  by  fire  of  all  the  plates  and 
electrotypes  of  the  former  edition  has  neces- 
sitated the  preparation  of  new  illustrations 
throughout  and  a  complete  remodelling  of  the 
book. 


Preface  to  the  Fourth  Edition. 


THE  plan  which  has  been  adopted  in  this 
book,  as  will  be  seen  at  a  glance,  is  to  teach 
by  numerous  illustrations  rather  than  by  elab 
orate  description  the  method  of  applying  the 
roller  bandage.  In  order  that  the  student 
may  most  readily  familiarize  himself  with  this 
very  important  subject,  a  series  of  illustra- 
tions is  presented  which  were  made  in  the 
following  manner :  Each  bandage  was  applied 
to  a  living  model,  and  whenever  the  roller 
pursued  a  course  which  the  author  has  found 
in  his  association  with  students  was  the  cause 
of  uncertainty  it  was  at  once  photographed. 
From  these  photographs  the  reproductions 
were  made.  In  this  way  it  is  hoped  that  the 
intricate  course  traversed  by  the  roller  in  the 
most  complex  dressing  has  been  made  suf- 
ficiently plain  to  enable  the  student  to  apply  it 


PREFACE   TO   THE   FOURTH    EDITION 

for  himself  almost  unaided  by  the  text.  The 
latter  will  be  found  very  brief  and  devoid  of 
everything  but  the  rule  for  application  and  the 
use  to  which  the  dressing  is  commonly  put. 

A  series  of  definitions  and  general  rules  for 
bandaging   occupy  the    earlier   pages  of  the 

book. 

W.  B.  H. 


Contents. 


THE  ROLLER  BANDAGE.  PAGE 

Definition 9 

Material 9 

Rolling , 10 

By  Hand 10 

By  Key „ 10 

By  Machine 12 

Size 13 

Uses 14 

Tension 14 

Varieties 19 

Parts 19 

APPLICATION. 

To  Fix 20 

To  Repeat 20 

To  Overlap 21 

To  Recur 21 

To  Reverse 22 

To  Reverse  Descending '. 24 

To  Secure 25 

To  Remove -.26 

ix 


CONTENTS 

SPECIAL  BANDAGES.  PAGE 

A  Circular  Bandage 26 

A  Spiral  Bandage 26 

An  Oblique  Bandage 27 

A  Spica  Bandage 27 

A  Figure-of-Eight  Bandage 28 

A  Spiral  Reversed  Bandage 28 

A  Recurrent  Bandage 28 

BANDAGES  OF  THE  HEAD. 

Barton's  Bandage 31 

Gibson's  Bandage 34 

Occipito-facial  Bandage  36 

Crossed  Bandage  of  the  Jaw 38 

Recurrent  Bandage 40 

Double-Headed  Recurrent  Bandage 41 

Figure-of-Eight  Bandage  of  one  Eye 44 

Figure-of-Eight  Bandage  of  both  Eyes 45 

Hunter's  V  Bandage 46 

White's  Head  and  Neck  Bandage 48 

Knotted  Bandage 49 

BANDAGES  OF  THE  UPPER  EXTREMITY. 

Desault's  Bandage 51 

Velpeau's  Bandage 63 

Figure-of-Eight  Bandage  of  the  Neck  and  Axilla 67 

Spica  Bandage  of  the  Shoulder 69 

Ascending 69 

Descending. . .- 72 

Spiral  Reversed  Bandage  of  the  Upper  Extremity 74 

Figure-of-Eight  Bandage  of  the  Elbow 79 

x 


CONTENTS 

PAGE 

Spica  Bandage  of  the  Thumb  81 

Ascending 81 

Descending 82 

Gauntlet  Bandage 83 

Demi-Gauntlet  Bandage 85 

BANDAGES  OF  THE  TRUNK. 

Spiral  Bandage  of  the  Chest 87 

Anterior  Figure-of-Eight  Bandage  of  the  Chest 88 

Posterior  Figure-of-Eight  Bandage  of  the  Chest 90 

Single  Spica  Bandage  of  the  Breast 91 

Double  Spica  Bandage  of  the  Breast 93 

BANDAGES  OF  THE  LOWER  EXTREMITY. 

Single  Spica  Bandage  of  the  Groin 97 

Ascending  Spica 97 

Descending  Spica 100 

Double  Spica  Bandage  of  the  Groin , .  102 

Ascending  Spica 102 

Descending  Spica 105 

Figure-of-Eight  Bandage  of  the  Knee 107 

Spica  Bandage  of  the  Foot 109 

Incomplete  Bandage  of  the  Foot in 

Complete  Bandage  of  the  Foot 1 13 

Spiral  Reversed  Bandage  of  the  Lower  Extremity. ...  116 

BANDAGES,  SLINGS,  BINDERS,  AND  KNOTS. 

T-Bandages 119 

of  the  Chest. 121 

of  the  Pubis 121 

of  the  Ear 123 

xi 


CONTENTS 

PAGE 

Slings 1 24 

Four-tailed 127 

Four-tailed  of  one  Eye 128 

Four-tailed  of  both  Eyes 1 28 

Four-tailed  of  the  Ear 129 

Four-tailed  of  the  Chin 130 

Binders 131 

Knots 134 

FIXED  DRESSINGS. 

Preparation  of  Plaster-of-Paris  Bandages 137 

Mode  of  Application 138 

Application  to  the  Leg 139 

Application  to  the  Hip 145 

Plaster-of-Paris  Jacket 146 

Removal  of  Fixed  Dressings 149 


List  of  Illustrations. 


FIG.  PAGE 

1.  Method  of  rolling  the  bandage  by  hand 10 

2.  Author's  key  for  rolling  bandages n 

3.  Method  of  rolling  the  bandage  with  the  key 12 

4.  Machine  for  rolling  bandages    13 

5.  Double-  and  single-headed  bandages 19 

6.  Illustrating  the  manner  of  making  recurrent  turns 21 

7.  Recurrent  bandage  of  the  stump 22 

8.  Manner  of  making  reverse 23 

9.  Manner  of  making  descending  reverse 24 

10.  Methods  of  securing  the  bandage 25 

ir.  Spiral  bandage  applied  without  reverses 27 

12.  Oblique  bandage 27 

13.  Manner  of  fixing  the  bandage  by  horizontal  turns 29 

14.  Manner  of  fixing  the  bandage  by  vertical  turns 30 

15.  Barton's  bandage,  first  turn  of 31 

16.  Barton's  bandage,  beginning  of  the  second  turn  of. ...  32 

17.  Barton's  bandage  completed  33 

18.  Gibson's  bandage 35 

19.  Occipito-facial  bandage  37 

20.  Crossed  bandage  of  the  jaw 39 

21.  Recurrent  bandage  of  the  scalp 40 

22.  Double-headed  recurrent  of  the  scalp,  first  turn  of  the  42 

23.  Double-headed  recurrent  of  the  scalp  completed 43 

24.  Figure-of-eight  bandage  of  the  eye 44 

xiii 


LIST  OF   ILLUSTRATIONS 

FIG.  PAGE 

25.  Figure-of-eight  bandage  of  both  eyes 45 

26.  Hunter's  V  bandage 46 

27.  White's  head  and  neck  bandage 48 

28.  Knotted  bandage 49 

29.  Wedge-shaped  axillary  pad 51 

30.  Desault's  dressing,  first  roller  of 52 

31.  Desault's  dressing,  second  roller  of 55 

32.  Desault,  manner  of  commencing  the  third  roller  of ...  56 

33.  Desault,  manner  of  continuing  the  third  roller  of 58 

34.  Desault's  dressing  completed 59 

35.  Author's  modification  of  third  roller  of  Desault 62 

36.  Velpeau's  bandage,  manner  of  commencing 64 

37.  Velpeau's  bandage,  course  of  the  first  spiral  turn  of  . .  65 

38.  Velpeau's  bandage  completed 66 

39.  Figure-of-eight  bandage  of  the  neck  and  axilla 68 

40.  Ascending  spica  of  the  shoulder,  first  turn  of  the 69 

41.  Ascending  spica  of  the  shoulder 71 

42.  Descending  spica  of  the  shoulder,  first  turn  of  the 72 

43.  Descending  spica  of  the  shoulder 73 

44.  Spiral  reversed  on  the  right  hand,  initial  turns  of 75 

45.  Spiral  reversed  on  the  left  hand,  initial  turns  of 75 

46.  Figure-of-eight  turns  above  and  below  the  thumb  ....  76 

47.  Point  at  which  reversing  begins 77 

48.  Spiral  reversed  bandage  of  the  upper  extremity  com- 

pleted  78 

49.  Figure-of-eight  bandage  of  the  elbow 80 

50.  Ascending  spica  of  the  thumb 81 

51.  Descending  spica  of  the  thumb 82 

52.  Gauntlet  bandage 84 

53.  Demi-gauntlet  bandage 85 

xiv 


LIST   OF    ILLUSTRATIONS 

FIG.  PMJB 

54.  Spiral  bandage  of  the  chest 87 

55.  Anterior  figure-of-eight  of  the  chest 89 

56.  Posterior  figure-of-eight  of  the  chest 90 

57.  Suspensory  of  the  breast,  initial  turn  of 92 

58.  Single  spica  or  suspensory  of  the  breast 93 

59.  Double  spica  of  the  breast,  initial  turns  of 94 

60.  Double  spica  or  suspensory  of  the  breast 95 

61.  Ascending  spica  of  the  groin,  initial  turns  of  the 98 

62.  Ascending  spica  of  the  groin 99 

63.  Descending  spica  of  the  groin,  initial  turns  of  the 100 

64.  Descending  spica  of  the  groin  completed 101 

65.  Double  ascending  spica  of  the  groin,  initial  turns  of  the  103 

66.  Double  ascending  spica  of  the  groin 104 

67.  Double  descending  spica  of  the  groin,  initial  turns  of  the  105 

68.  Double  descending  spica  of  the  groin 106 

69.  Figure-of-eight  bandage  of  the  knee 108 

70.  Spica  bandage  of  the  foot no 

71.  Incomplete  bandage  of  the  foot,  initial  turns  of  the  ...  in 

72.  Incomplete  bandage  of  the  foot 112 

73.  Heel  turn  in  the  complete  bandage  of  the  foot. 113 

74.  Inner  malleolar  turn  in  the  complete  bandage  of  the 

foot 114 

75.  Outer  malleolar  turn  in  the  complete  bandage  of  the 

foot 115 

76.  Spiral  reversed  bandage  of  the  lower  extremity 117 

77.  Single  T-bandage 118 

78.  Double  T-bandage 119 

79.  T-bandage  of  the  chest 120 

80.  T-bandage  of  the  pubis 122 

81.  Roller  bandage  sling  of  the  forearm , 124 

xv 


LIST   OF   ILLUSTRATIONS 
FIG.  PAGE 

82.  Handkerchief  sling  of  the  forearm 125 

83.  Four-tailed  sling 126 

84.  Four-tailed  sling  of  the  eye 127 

85.  Four-tailed  sling  of  both  eyes 128 

86.  Four-tailed  sling  of  the  ear 129 

87.  Four-tailed  sling  of  the  chin 130 

88.  Many-tailed  binder 132 

89.  Method  of  applying  the  binder 133 

90.  Double  half-hitch  of  roller  bandage 134 

91.  Double  half-hitch  of  a  sheet 135 

92.  Ankle  hitch  for  temporary  extension 136 

93.  Plaster  bandages,  method  of  making 137 

94.  Method  of  suspending  a  fractured  leg  for  the  applica- 

tion of  a  fixed  dressing 141 

95.  Trap-door ;  also  vertebrated  chain  to  facilitate  removal 

of  fixed  dressing 144 

96.  Pelvic  rest  used  for  the  application  of  a  fixed  dressing 

to  the  hip 145 

97.  Suspension  apparatus  for  the  application  of  a  plaster- 

of- Paris  jacket 147 

98.  Hammock  for  the  application  of   a  plaster-of-Paris 

bandage 148 

99.  T-shaped  rubber  strip 150 

100.  Reed's  cutter 152 

101.  Van  Brun's  cutter 153 

102.  Plaster  shears 153 

103.  Darrach's  cutter 154 

104.  Pearson's  circular  saw 155 

105.  Saw 155 


The  Roller  Bandage. 


Definition. — The  term  roller  bandage  is 
used  to  describe  a  strip  of  muslin  or  other 
material  rolled  into  a  cylindrical  form.  When 
other  material  than  muslin  is  employed,  how- 
ever, the  bandage  is  usually  designated  as 
a  rubber,  a  gauze,  a  flannel,  or  a  crinoline 
bandage. 

Materials. — Unbleached  muslin  of  medium 
quality  is  best  adapted  for  the  purposes  of 
the  ordinary  roller.  This  is  torn  into  strips 
of  the  required  length  and  breadth,  remov- 
ing the  selvage  and  leaving  the  ravel  as 
much  undisturbed  as  possible.  Gauze  for 
aseptic  bandages  and  crinoline  for  plaster- 
of-Paris  are  cut  into  strips  of  the  required 
dimensions,  as  these  materials  cannot  be 
torn  evenly.  India-rubber  rollers  are  usually 

9 


THE    ROLLER   BANDAGE 

procured  ready  made,  though  pure  rubber 
sheeting  of  different  weights  is  available  for 
special  bandages. 

Rolling. — The  strip  of  muslin  having  been 
torn,  may  be  rolled  either  by  hand,  by  a  key, 

FIG.   i. 


Method  of  rolling  the  bandage  by  hand. 

or  by  a  machine.  In  rolling  by  hand,  one 
extremity  of  the  bandage  is  folded  upon  itself 
three  or  four  times,  when  it  is  handled  as  a 
cigarette  is  rolled  until  the  core  becomes 
sufficiently  firm  to  resist  pressure  on  end. 
It  is  then  held  between  the  thumb  and  index 


THE   ROLLER   BANDAGE 

finger  of  the  left  hand,   and  is  made  to  re- 
volve upon  its  long  axis  by  the  thumb  and 
fingers  of  the  right  hand,  as  shown  in  Fig.  i. 
A  bandage  may  be  more  quickly  and  firmly 
rolled  by  using  a  key,  shown  in  Fig.  2.     This 

FIG.  2. 


Author's  key  for  rolling  bandages. 

is  made  of  brass,  has  an  ordinary  key-handle, 
a  tapering  octagonal  shaft,  and  a  smooth  tip. 
The  dimensions  of  the  shaft  are, — four  inches 
in  length,  one-quarter  of  an  inch  in  diameter 
at  the  shoulder,  and  one-fifth  at  the  tip.  After 
fixing  one  extremity  of  the  bandage  on  the 
key,  the  latter  is  made  to  revolve  by  the  right 
hand,  while  the  left  holds  the  tip  of  the  in- 
strument in  its  palm,  and  guides  the  course 
of  the  bandage  between  the  thumb  and 
fingers.  When  the  roller  has  reached  a 


THE   ROLLER   BANDAGE 

certain  size,  it  may  be  held  in  the  manner 
shown  in  Fig.  3.  Any  tendency  of  the  roller 
to  run  off  its  proper  course  may  be  overcome 
by  pressure  with  the  little  finger  of  the  left 


FIG.  3. 


Method  of  rolling  the  bandage  with  the  key. 

hand,  if  it  deviates  towards  the  handle  of  the 
key,  and  by  pressure  with  the  index  finger  if 
towards  the  tip. 

The  bandage  machine  consists  of  a  reel, 
with  a  crank  and  octagonal  shaft,  mounted 
upon  a  base  which  is  made  to  screw  to  a 
table.  Set  in  the  base  are  two  uprights, 
which  support  wcoden  rods.  Through  these 


12 


THE   ROLLER   BANDAGE 

the  bandage  travels  in  its  course  from  the 
left  hand  to  the  reel,  their  object  being  to 
regulate  the  direction  and  tension  of  the 

FIG.  4. 


Machine  for  rolling  bandages. 

roller.  After  the  bandage  is  rolled,  it  may 
readily  be  withdrawn  from  the  machine  by 
reversing"  the  direction  of  the  crank  and 

o 

pulling  out  the  shaft,   as   the   latter  is   quite 
movable.     This  apparatus  is  shown  in  Fig.  4. 
Size. — Although    bandages  vary   in    length 
13 


THE    ROLLER   BANDAGE 

from  two  to  ten  yards,  and  in  width  from 
three-quarters  of  an  inch  to  four  inches,  there 
are  two  sizes  in  common  use  with  which  al- 
most any  dressing  may  be  applied.  They 
are  the  roller  (two-and-a-half  inches  by  seven 
yards)  and  the  finger  roller  (three-quarters  of 
an  inch  by  three  yards).  For  children,  a 
bandage  about  half  the  length  and  breadth 
of  one  suitable  for  an  adult  may  be  used. 

Uses. — The  roller  bandage  is  used  for  so 
great  a  variety  of  purposes  that  it  would  be 
quite  beyond  the  scope  of  these  definitions 
to  attempt  to  enumerate  them,  except  in  the 
most  general  way.  To  retain  almost  all 
dressings  and  splints  ;  and,  by  giving  support 
or  pressure,  to  prevent  or  control  oedema, 
oozing  of  blood  or  serum,  spasm  of  muscles 
after  fracture,  or  as  itself  a  fracture  dressing. 

Tension. — Too  much  care  cannot  be  exer- 
cised in  applying  a  bandage  in  each  individual 
case,  to  estimate  how  much  tension  should  be 
used,  in  order  to  fulfil  the  object  for  which  it 
is  employed,  advantageously  and  prudently. 

14 


THE   ROLLER   BANDAGE 

A  bandage  may  be  applied  tightly,  moder- 
ately, or  loosely.  These  grades  may  be  readily 
tried  upon  one's  own  person.  A  tight  band- 
age makes  a  healthy  hand  throb.  A  bandage 
moderately  applied  gives  the  support  of  a 
comfortable  glove,  and  a  loose  bandage  is 
one  which  may  retain  a  compress  resting 
upon  the  eye  without  causing  discomfort. 
The  conditions  governing  the  tension  of 
the  roller  will  be  formulated  as  (a)  those 
depending  upon  the  roller  itself,  and  (b]  those 
which  exist  in  the  part  bandaged  : 

a.  i .  The  Circumference  of  the  Part  Band- 
aged.— The  greater  the  circumference,  the 
more  force  must  be  used.  Thus,  in  applying 
a  roller  to  the  lower  extremity,  it  is  necessary, 
in  order  to  secure  an  equal  support  for  the 
entire  limb,  that  each  successive  turn  cover- 
ing a  greater  circumference  should  be  drawn 
a  little  more  firmly  than  the  preceding  turn. 
The  thigh  turns  require,  therefore,  consider- 
ably more  force  to  produce  a  given  tension 
than  those  at  the  ankle. 

15 


THE    ROLLER   BANDAGE 

2.  Whether  the  Bandage  includes  the  entire 
or  only  half  the  Circumference  of  the  Limb,  as 
in  the  Application  of  Splints. — When   these 
are  applied,    much   of  the    force    used   is   di- 
rected   upon    them,    the    limb    receiving   less 
pressure  than  if  the  roller  surrounds  it  alone. 

3.  Incomplete    Bandaging. — Any    bandage 
which  leaves  a   considerable    portion   of   the 
distal  extremity  of  a  limb  uncovered  is  very 
liable    to    induce    swelling.       If  the    hand   or 
the  foot  is  left  uncovered,  while  the  rest  of 
the  limb  is  bandaged,   swelling  is  very  likely 
to  occur.       Once  started,  it  progresses  very 
rapidly,   because  it  increases   the   tension  of 
the  lower  border  of  the  bandage.     This  of 
course  promotes   the  swelling,   and   so   these 
active   and   passive   agents   may  react   upon 
each  other  to  the  complete  strangulation  of 
the  limb. 

4.  The  Character  of  the  Dressing  beneath. — 
Where  a  mass  of  soft  yielding  material  like 
cotton    or   gauze    is    interposed,    much    more 

force  is  necessary  to  give  the  requisite  tension 

16 


THE   ROLLER   BANDAGE 

than  where  a  thin  dressing  or  none  at  all  is 
used. 

5.  Increase  of  Tension  from  Flexion  or  Ex- 
tension.— If  a  spica  bandage  is  applied  to  the 
shoulder  with  the  arm   elevated,   its  tension 
will  be  much  increased  by  bringing  the  arm 
to  the  side  of  the  body.     In  the  same  manner 
the  tension  of  a  spica  of  the  groin,  applied 
with  the  thigh  flexed  upon  the  abdomen,  will 
be  increased  when  the  latter  is  extended. 

6.  The  Number  of  Turns. — Each  additional 
turn  applied  to  the  same  part  of  a  limb  in- 
creases   the    tension    nearly  double.     When, 
therefore,  a  roller  starts  at  the  wrist,  passes 
to   the  hand,   and   returns   to   the  wrist,   the 
latter  receives  too  much  tension,   unless  the 
first  wrist  turns  are  made  very  loosely.     The 
same  is  true  to  a  less  extent  when  successive 
turns  are  made  very  close  together. 

7.  Shrinkage. — Due    allowance    should   al- 
ways be  made  for  shrinking  of  the  muslin,  if 
it  is  known  or  suspected  that  from  any  cause 

it  will  become  wet. 

17 


THE   ROLLER   BANDAGE 

b.  i .  Texture  and  Condition  of  the  Tissues. 
— Hard  infiltrated  tissue,  such  as  is  frequently 
found  accompanying  ulcers  of  the  leg,  requires 
very  firm  pressure,  while  very  moderate  press- 
ure only  can  be  employed  in  bandaging  the 
flabby,  unresisting  limbs  of  delicate  children 
and  aged  persons.  An  acute  inflammatory 
condition  of  a  part  will  not  admit  of  pressure, 
while  very  considerable  tension  is  well  borne 
by  a  doughy,  cedematous  condition  of  the 
tissues. 

2.  Habit. — Independent  of  advance  or  sub- 
sidence of  swelling,  a  bandage  may  be  applied 
more  firmly  when    the   patient    has    become 
accustomed  to  its  presence. 

3.  Situation. — Care  must  be  observed,  when 
bandages  about  the  chest  are  applied,  that  res- 
piration shall  not  be  interfered  with,  particu- 
larly if  the  dressing  is  completed  before  the 
patient  has  quite  recovered  from  the  effects 
of  an  anaesthetic. 

4.  Change   in   Position. — Marked    swelling 

always  occurs  when  a  limb  which  has  been 

is 


THE   ROLLER   BANDAGE 


kept  horizontal  for  many  weeks  is  suddenly 
allowed  to  hang.  In  this  way  a  fixed  dressing 
of  silicate  of  sodium  or  plaster-of-Paris,  com- 
fortable while  the  patient  is  on  his  back,  fre- 
quently has  to  be  cut  when  he  gets  up. 

Varieties. — The  single  roller,  which  is  almost 
invariably  used,  and  the  double  roller.  They 
are  shown  in  Fig.  5. 

FIG.  5. 


Double-  and  single-headed  bandages. 

Parts  of  the  Roller. — The  single  roller  is 
composed  of  seven  parts, — the  initial  and 
terminal  extremities,  the  upper  and  lower 
borders,  the  external  and  internal  surfaces, 
and  the  body.  The  initial  extremity  is  the 
free  end,  while  the  terminal  extremity  is  that 

19 


THE   ROLLER   BANDAGE 

in  the  centre  of  the  cylinder.  The  borders, 
upper  and  lower,  are  designated  according 
to  the  position  they  occupy  when  the  sub- 
ject stands  erect.  The  surfaces,  inner  and 
outer,  are  denoted  by  their  relation  to  the 
centre  of  the  cylinder,  and  the  body  includes 
all.  The  double  roller  has  eight  parts, — two 
terminal  extremities,  two  borders,  two  sur- 
faces, two  bodies,  and  no  initial  extremity. 

Application. 

To  Fix. — A  roller  is  fixed  by  placing  the 
outer  surface  of  the  initial  extremity  upon 
the  point  at  which  it  is  to  start  and  holding 
it  with  the  thumb  and  index  finger  of  the 
left  hand.  With  the  body  of  the  roller  held 
in  the  right  hand  two  turns  are  made  in  the 
direction  taken  by  the  hands  of  a  clock.  The 
first  turn  must  be  made  by  the  right  hand 
alone,  after  which  the  left  hand,  being  free, 
may  alternate  with  it. 

To  Repeat. — To  repeat  is  to  make  a  second 
turn  completely  hide  a  preceding  turn.  This 


20 


THE    ROLLER   BANDAGE 

is  always  done  in  a  circular  bandage,  and  in 
fixing  the  initial  extremity. 

To  Overlap. — To  overlap  is  to  make  a  second 
turn  cover  one-half,  two  thirds,  or  three-quar- 
ters of  a  preceding  turn.  This  is  done  in  all 
spirals. 

FIG.  6. 


Illustrating  the  manner  of  making  recurrent  turns. 


To  l^ccur. — To  recur  is  to  catch  a  turn  at 
some  point  and  reflect  it  upon  itself,  .so  that 
j,t  either  exactly  retraces  its  course  or  slightly 
diverges  in  another  direction  (Fig.  6).  This 


21 


THE   ROLLER   BANDAGE 

is  done  in  recurrents  of  the  stump  (Fig.   7) 
and  the  recurrent  of  the  scalp.     (See  Fig.  2 1 .) 


FIG.  7. 


Recurrent  bandage  of  the  stump. 

To  Reverse. — To  reverse  is  to  bring  the 
inner  surface  of  the  roller  next  the  skin  in- 
stead of  the  external.  The  right  hand  being 
in  a  state  of  supination  when  it  receives  the 
body  of  the  roller  from  the  left,  makes  a 
reverse  by  simply  being  pronated  (Fig.  8). 
While  the  right  hand  effects  this  movement, 
the  thumb  or  index  finger  of  the  left  is  placed 
upon  the  last  turn,  which  has  been  applied  in 
order  to  retain  it  in  position,  as  the  free  por- 
tion of  the  roller  should  hang  perfectly  slack 
when  the  reverse  is  being  made.  After 

22 


THE   ROLLER   BANDAGE 

making  the  reverse,  the  roller  is  passed 
around  the  limb  and  delivered  to  the  left 
hand,  and  not  until  then  is  the  traction  neces- 
sary to  produce  the  required  tension  em- 
ployed. The  succeeding  reverses  are  made 

FIG.  8. 


Showing  manner  of  making  reverse. 

in  the  same  manner,  and  they  will  be  even 
and  symmetrical  if  the  thumb  or  index  finger 
of  the  left  hand  is  placed  in  the  same  per- 
pendicular line  it  before  occupied  while  retain- 
ing the  preceding  turn,  and  if  each  turn  is 

23 


THE   ROLLER   BANDAGE 

made  to  overlap  the  preceding  one  to  the 
same  extent  in  its  entire  circumference.  The 
object  of  the  reverse  is  to  make  the  roller 
adapt  itself  to  a  conical  cylinder,  whose  diam- 
eter is  increasing,  as  from  the  ankle  to  the 
calf  of  the  leg. 

FIG.  9. 


Showing  manner  of  making  descending  reverse. 

To  Reverse,  Descending. — To  make  a  descend- 
ing reverse,  the  right  hand  is  placed  in  a  state 
of  pronation  when  about  to  receive  the  body 
of  the  roller  from  the  left,  and  is  simply  turned 

24 


THE   ROLLER   BANDAGE 

to  supination,  while  the  left  thumb  retains  the 
turn  already  made  as  in  the  ordinary  reverse 
(Fig.  9).  The  descending-  reverse  becomes 
necessary  when  the  roller  is  applied  to  a  part 
the  diameter  of  which  is  constantly  diminish- 
ing, as  in  the  leg  from  the  calf  to  the  knee 
when  the  former  is  very  large,  and  when 
thickly  padded  splints  are  applied  to  the 
hand,  etc. 

To    Secure. — To    secure    the    terminal    ex- 
tremity of  the   roller,   either  a  pin  is   used, 

r 

FIG.  10. 


Methods  of  securing  the  bandage. 

which  includes  one  or  more  of  the  previous 
turns,  or  the  end  is  slit  into  two  .tails,  which 
are  carried  around  the  part  in  opposite  direc- 
tions and  tied.  The  pin  may  be  introduced 
parallel  or  at  right  angles  with  the  long  axis 
of  the  limb.  These  methods  of  securing  are 

25 


THE    ROLLER   BANDAGE 

shown  in  Fig.  10.  The  pin  should  always  be 
directed  downwards  ;  it  should  appear  to  view 
at  least  twice  in  its  course  through  the  under- 
lying layers  of  muslin,  and  its  point  should 
be  carefully  buried.  These  precautions  are 
necessary  to  prevent  the  pin  doing  harm,  as 
the  hand  of  the  operator  is  usually  carried 
down  the  limb  to  ascertain  if  the  roller  has 
been  properly  applied. 

To  Remove. — When  removing  the  roller, 
each  turn  should  be  gathered  compactly  in 
the  hand,  no  loops  or  ends  being  allowed  to 
trail. 

Special  Bandages. 

A  Circular  Bandage. — A  circular  bandage 
consists  of  a  series  of  three  turns  which 
repeat  each  other. 

A  Spiral  Bandage. — A  spiral  bandage  is  one 
each  turn  of  which,  after  the  initial  extremity 
has  been  fixed,  overlaps  one-half,  two-thirds, 
or  three-quarters  of  the  preceding  turn.  Such 

a  bandage  applied  to  a  part  having  varying 

26 


THE   ROLLER   BANDAGE 

diameters   will    not   adapt   itself  evenly   and 
neatly  (Fig.  n). 


FIG.  ii. 


Spiral  bandage  applied  without  reverses. 

An  Oblique  Bandage. — An  oblique  bandage 
resembles  a  spiral,  except  that  the  limb  is 
ascended  so  rapidly  that  the  borders  of  the 


FIG.  12. 


Oblique  bandage. 

turns  do  not  touch  one  another.  It  is  only 
used  to  retain  a  temporary  or  loose  dressing 
(Fig.  12). 

A  Spica  Bandage. — A  spica  bandage  is  com- 
posed of  two  sets  of  turns  alternating  with 

27 


THE   ROLLER   BANDAGE 

one  another,  and  coming  in  contact  only  at 
the  point  where  it  is  intended  to  make  press- 
ure or  retain  a  dressing.  (See  Fig.  41, 
page  71.) 

A  Figure-of-Eight  Bandage. — A  figure-of-eight 
bandage  frequently  resembles  a  spica  very 
closely.  It  also  is  composed  of  two  sets  of 
turns  made  in  different  directions,  but  the 
direction  of  these  turns  gradually  converges. 
(See  Fig.  49,  page  80.) 

A  Spiral  Reversed  Bandage. — A  spiral  re- 
versed bandage  consists  of  a  series  of  spiral 
turns,  most  of  which  have  been  reversed. 
(See  Fig.  48,  page  78.) 

A  Recurrent  Bandage. — A  recurrent  bandage 
is  composed  of  a  series  of  recurrent  turns. 
(See  To  Recur,  page  21.) 


28 


Bandages  of  the  Head. 


ALL  bandages  applied  to  the  head,  except 
Barton's,   are  fixed    either   by  circular  turns 


FIG.   13. 


Manner  of  fixing;  the  bandage  by  horizontal  turns. 

running  horizontally  about  the  vault  of  the 
cranium,  or  by  circular  turns  vertically  around 

29 


THE   ROLLER   BANDAGE 

the  face.  After  the  former  method  are  fixed 
the  crossed  of  the  angle  of  the  jaw,  recurrent 
of  scalp,  figure-of-eights  of  the  eye.  Hunter's, 


FIG.  14. 


Manner  ot  fixing  the  bandage  by  vertical  turns. 

White's,  and  the  knotted  bandage  (Fig.  13), 
while  Gibson's  and  the  occipito-facial  are  fixed 
by  the  latter  (Fig.  14). 


BANDAGES   OF   THE    HEAD 


Barton's  Bandage. 

2  inches  by  5  yards. 

Place  the  initial  extremity  of  the  roller  be- 
hind the  ear  on  the  sound  side.     Carry  the 

FIG.   15. 


The  first  turn  of  Barton's  bandage. 


roller  beneath  the  occiput  to  a  corresponding 
point    behind    the   ear   on   the    injured   side. 

31 


THE   ROLLER   BANDAGE 

Thence  to  the  vertex,  and  down  the  sound 
side  of  the  face  to  the  chin.  Up  on  the  in- 
jured side  to  the  vertex,  intersecting  the 

FIG.   16. 


The  beginning  of  the  second  turn  of  Barton's  bandage. 

former  turn  directly  in  the  median  line,  and 
back  to  the  starting-point.  Not  until  then  is 
the  bandage  fixed.  The  fingers  holding  the 

32 


BANDAGES    OF   THE    HEAD 

initial  extremity  are  now  released,  and  the 
roller  may  be  conveniently  passed  from  one 
hand  to  the  other  (Fig.  15).  The  roller 
passes  from  here  to  the  occiput,  and  along 

FIG.  17. 


Barton's  bandage  completed. 

the  injured  side  of  the  jaw  to  the  chin,  and 
back  to  the  occiput.  From  the  occiput  to  the 
vertex  (Fig.  16).  Each  of  these  turns  is  re- 
peated in  a  similar  manner  twice,  when  the 
3  33 


THE    ROLLER   BANDAGE 

bandage  is  terminated  at  the  vertex.  Every 
intersection  of  turns  requires  a  pin  (Fig.  17). 

Uses. — Fracture  of  the  body  of  the  lower 
jaw,  after  luxation,  and  to  retain  dressings  at 
various  .points  along  the  .course  traversed  by 
the  bandage. 

It  is  also  a  useful  substitute  for  the  leather 
head-gear  of  Sayre's  suspension  apparatus 
for  applying  the  plaster  jacket,  when  the 
latter  is  not  available. 


Gibson's  Bandage. 

2  inches  by  5  yards. 

Fix  the  roller  by  vertical  turns  around  the 
face.  The  direction  it  takes  in  starting  is  de- 
termined by  the  location  of  the  fracture,  the 
roller  always  ascending  on  the  injured  side. 
After  making  three  of  these  vertical  turns,  a 
right-angled  reverse  is  made  at  the  temple, 
on  whichever  side  is  more  convenient,  and 
the  bandage  is  carried  back  to  the  occiput 

34 


BANDAGES   OF   THE    HEAD 

(Fig.  14).  Three  horizontal  turns  are  then 
made  around  the  vault  of  the  cranium,  and,  on 
reaching  the  occiput  the  third  time,  the  chin 

FIG.  1 8. 


Gfbson'i  bandage. 

turns  are  begun.  These  are  made  by  carrying 
the  roller  beneath  the  ear,  along  the  side  of 
the  jaw,  to  the  front  of  the  chin,  and  back  to 
the  occiput.  Three  of  these  turns  are  made. 

35 


THE   ROLLER   BANDAGE 

On  reaching  the  occiput  the  third  time,  the 
bandage  is  completed  by  a  right-angled  re- 
verse at  this  point,  whence  it  is  carried  over 
the  top  of  the  head  to  the  forehead  in  the 
median  line  (Fig.  18).  A  pin  is  introduced  at 
the  reverse  over  the  occiput,  and  at  each  inter- 
section. The  dressing  will  be  seen  to  consist 
of  three  sets  of  circular  turns. 

Uses. — Fracture  of  the  body  of  the  lower 
jaw,  after  luxation,  and  to  retain  dressings. 


Occipito-Facial  Bandage. 

2  inches  by  2  yards. 

Fix  the  roller  by  vertical  turns  around  the 
face.  After  making  three  of  these  turns,  re- 
verse over  the  temple  on  the  more  convenient 
side,  carry  the  roller  to  the  occiput,  and  back 
to  the  opposite  temple.  It  may  be  pinned 
here  (Fig.  19),  or  continued  around  the  fore- 
head to  the  point  at  which  the  reverse  was 
made.  The  reverse  must  also  be  pinned. 

36 


BANDAGES   OF   THE    HEAD 

The  bandage  consists  simply  of  the  first  and 
part  of  the  second  circulars  of  Gibson's. 


FIG.   19. 


Occipito-facial  bandage. 


Uses. — To  restrict  the  movement  of  the  jaw 
after  luxation,  and  to  retain  dressings. 


37 


THE    ROLLER   BANDAGE 
Crossed  Bandage  of  the  J&w. 

2  inches  by  5  yards. 

Fix  the  roller  about  the  vault  of  the  cranium, 
delivering  it  from  the  left  to  the  right  hand,  if 
the  jaw  is  fractured  on  the  left  side,  and  from 
the  right  to  the  left,  if  the  fracture  is  on  the 
right  side.  On  reaching  the  occiput  the  third 
time,  carry  the  roller  beneath  the  ear,  under 
the  chin  to  the  angle  of  the  mouth  on  the 
opposite  side.  Ascend  to  the  vertex.  De- 
scend behind  the  ear  on  the  sound  side  to  the 
throat,  and  up  again  on  the  injured  side  to 
the  vertex.  Each  ascending  turn  overlaps 
the  preceding  turn  three-quarters.  Each  de- 
scending turn  passes  behind  the  ear  on  the 
sound  side,  and  exactly  repeats  the  preceding 
turn.  So  continue  until  the  angle  of  the  jaw 
on  the  injured  side  is  covered.  This  is  usually 
accomplished  in  about  four  turns,  when  the 
bandage  may  be  pinned  (Fig.  20),  or  a  right- 
angled  reverse  made  over  the  temple,  and  a 

38 


BANDAGES    OF   THE   HEAD 

circular  turn,  repeating  those  applied  at  the 
beginning,  carried  around  the  head. 


FIG.  20. 


Use. — Fracture    of    the    lower    jaw    with 
lateral  displacement. 


39 


THE   ROLLER   BANDAGE 


Recurrent  Bandage. 

2  inches  by  7  yards. 

Fix  the  roller  about  the  vault  of  the 
cranium.  On  reaching  the  occiput  the  third 
time,  make  a  right-angled  reverse,  and  carry 

FIG.  21. 


Recurrent  bandage  of  the  scalp. 

the  roller  in  the  median  line  over  the  top  of 
the  head  to  the  brow,  at  which  point  the 
finger  of  an  assistant  must  hold  the  band- 
age. Recur  to  the  occiput,  overlapping  three- 

4o 


BANDAGES   OF   THE    HEAD 

quarters  of  the  first  turn  on  one  side.  Recur 
to  the  forehead,  overlapping  three-quarters  on 
the  other  side  of  the  first  turn.  So  continue 
until  the  entire  scalp  is  covered,  when  two 
circular  turns  are  made  to  fix  the  recurrents. 
Pin  deeply  into  the  layers  in  front  and  at  the 
the  back  (Fig.  21). 

Uses. — To  retain  dressings  to  the  scalp,  and 
to  make  compression. 


Double-Headed  Recurrent  Bandage. 

2  inches  by  14  yards. 

Place  the  free  portion  between  the  two 
bodies  of  the  roller  upon  the  forehead  and  by 
carrying  the  heads  around  the  vault  of  the 
cranium  make  one  horizontal  turn.  At  the 
occiput  a  hitch  is  made,  and  while  one  head 
of  the  bandage  is  carried  forward  accurately 
in  the  median  line,  the  other  head  begins 
its  continuous  course  horizontally  about  the 
vault  of  the  cranium.  Passing  beneath  this 

41 


THE    ROLLER   BANDAGE 

(Fig.  22),  the  recurrent  head  of  the  bandage 
is  reflected  upon  itself,  and  diverging  to  the 
left  from  its  original  course  so  that  it  shall 
overlap  the  preceding  turn  three-quarters  of 
its  width  at  the  vertex,  it  is  carried  back  to 

FIG.  22. 


The  first  turn  of  the  double-headed  recurrent  of  the  scalp. 

the  occiput.  Here,  again  retained  firmly  in 
place  by  the  horizontal  head,  it  is  reflected 
upon  itself  and  carried  forward  to  the  right 
of  the  median  line.  '  Thus  each  recurrent  turn 

is  retained  by  a  circular  turn  both  anteriorly 

42 


BANDAGES   OF  THE   HEAD 

and  posteriorly  until  a  sufficient  number  are 
made  to  completely  cover  the  scalp  (Fig.  23), 
when  the  terminal  ends  are  pinned  together 
at  any  convenient  point. 

FIG.  23. 


The  double-her 


t  of  the  scalp  completed. 


Uses. — To  retain  dressings  in  restless  or 
delirious  subjects.  Though  somewhat  diffi- 
cult to  apply  neatly,  it  is  so  secure  that  it 
cannot  become  disarranged. 


43 


THE   ROLLER   BANDAGE 
Figure-of-Eight  Bandage  of  One  Eye. 

2  inches  by  5  yards. 

Fix  the  roller  about  the  vault  of  the  cranium, 
bandaging  from  left  to  right,  if  the  right  eye 
is  to  be  covered,  and  from  right  to  left,  if  the 

FIG.  24. 


Figure-of-eight  bandage  of  the  eye. 

left  eye.  On  reaching  the  occiput  the  third 
time,  pass  the  bandage  below  the  ear,  across 
the  eye,  and  to  the  tuberosity  of  the  parietal 
bone  on  the  opposite  side.  Thence  to  the 
occiput.  Repeat  this  turn  twice,  and  again 

44 


BANDAGES   OF   THE    HEAD 

follow  the  initial  turns  around  the  head.     Pin 
both  intersections  (Fig.  24). 

Uses. — To  retain  dressings,  and  make  com- 
pression upon  the  orbit. 


Figure-of- Eight  Bandage  of  Both  Eyes. 

2  inches  by  7  yards. 

Fix   the   roller   around   the   head.      Cover 
one  eye  as   in   the  preceding  bandage,  and, 

FIG.  25. 


Figure-of-eight  bandage  of  both  eyes. 


after   making   one    circular   about   the  head, 
proceed,  on  reaching  the  forehead,  to  cover 

45 


THE   ROLLER   BANDAGE 
the    other    eye    in   a    similar    manner    (Fig. 


Uses.  —  To    retain    dressings,    or    compress 
both  eyes. 

Hunter's  V  Bandage. 

2  inches  by  3  yards. 

Fix  the  roller  about  the  vault  of  the  cranium. 
On  reaching  the  occiput  the  third  time,  carry 

P'lG.    26. 


Hunter's  V  bandage. 


the  bandage  beneath  the  ear,  along  the  jaw 

to  the   front   of   the  chin,   and   back  to  the 

46 


BANDAGES   OF   THE    HEAD 

occiput.  Then  alternate  between  head  and 
chin  turns,  making  two  or  three  of  each. 

o 

This  bandage  follows  the  same  course  as 
the  second  and  third  circulars  of  Gibson's 
(Fig.  26). 

Uses. — To    retain    dressings    after    injuries 
and  operation  about  the  chin  or  lower  lip. 


47 


THE   ROLLER   BANDAGE 
White's  Head  and  Neck  Bandage. 

2  inches  by  3  yards. 

Fix  the  roller  about  the  vault  of  the  cranium, 
and  on  reaching  the  occiput  the  third  time 

FIG.  27. 


White's  head  and  neck  bandage. 

pass  directly  down  in  front  of  the  throat. 
Alternate  two  or  three  head  and  neck  turns, 
and  pin  the  bandage  at  the  most  convenient 
point  (Fig.  27). 

Uses. — To    retain    dressings    after    injuries 

and  operation  of  the  throat  or  neck. 

48 


BANDAGES   OF  THE   HEAD 
Knotted  Bandage. 

2  inches  by  7  yards. 

For  this  a.  double-headed  roller  is  employed. 
Place  the  free  portion  between  the  bodies  upon 
the  temple  on  the  injured  side,  and  carry  the 

FIG.  28. 


heads  around  the  vault  of  the  cranium  to  A 
corresponding  point  on  the  opposite  side. 
Here  the  heads  of  the  roller  pass  each  other, 
and  continue  their  course  back  to  the  starting- 

4  49 


THE   ROLLER   BANDAGE 

point.  When  this  point  is  reached,  they  make 
a  half  turn  upon  each  other,  and  pursue  a 
vertical  course  around  the  face,  passing  as 
before  on  the  sound  side.  Reaching  the  in- 
jured side  again,  another  hitch  is  made,  and 
the  roller  is  carried  horizontally  around  the 
head.  So  alternate  face  and  head  turns  until 
three  or  four  knots  have  been  made,  when 
the  terminal  extremities  may  be  tied  together 
or  pinned  at  the  most  convenient  point  (Fig. 

28). 

Use. — To  make  pressure  upon  the  temple, 
especially  for  the  control  of  hemorrhage. 


bandages  of  the  Upper  Extremity. 


Desault's  Dressing. 

THIS   bandage  is  compound   in  character, 
requiring  for  its  application  three  rollers  and 

FIG.  29. 


Wedge-shaped  axillary  pad. 

a  wedge-shaped  pad.  The  pad  is  made  of 
strong  muslin  stuffed  with  hair  or  bran,  is 
about  five  inches  square,  two  inches  thick  at 
the  base,  and  bevels  off  to  nothing  at  its 
apex  (Fig.  29). 


THE   ROLLER   BANDAGE 

First  Roller  of   Desault. 
2J^  inches  by  5  yards. 

Place  the  initial  extremity  of  the  roller  on 
the  pad,  the  base  of  which  is  thrust  into  the 

FIG.  30. 


First  roller  of  Desault's  dressing. 


axilla   on    the   injured   side,   and   make    four 
spiral  turns,   encircling  the  thorax  and  pad. 

52 


BANDAGES    OF   THE   UPPER   EXTREMITY 

On  reaching  the  pad  the  fourth  time,  carry 
the  roller  well  down  under  its  apex,  and 
thence  across  the  front  of  the  chest  to  the 
shoulder  on  the  sound  side.  Here  a  figure- 
of-eight  turn  around  the  arm  is  made,  and  the 
roller  conveyed  across  the  back  to  the  apex 
of  the  pad  again.  Two  more  of  these  turns 
are  made,  either  repeating  each  other,  or,  as 
shown  in  Fig.  30,  overlapping  to  form  a  spica 
on  the  shoulder.  The  terminal  extremity  is 
then  pinned  at  the  most  convenient  point  in 
front. 

Use. — The  spiral  turns  are  to  fix  the  pad, 
and  the  figure-of-eight  turns  to  force  it  up 
into  the  axilla.  A  mass  of  oakum  compressed 
into  a  wedge-shaped  form  and  folded  in  lint 
or  muslin  may  well  be  used  instead  of  the 
prescribed  pad,  as  it  better  retains  its  position 
and  can  be  renewed  at  each  dressing. 


53 


THE   ROLLER   BANDAGE 

Second  Roller  of   Desault. 
2^  inches  by  7  yards. 

Fix  the  initial  extremity  of  the  roller  by 
two  circular  turns,  which  include  the  thorax 
and  the  arm  on  the  injured  side.  They  pass 
over  the  head  of  the  humerus  and  under  the 
sound  axilla.  Descend  the  chest  and  arm  by 
spirals,  overlapping  one-half.  These  turns 
must  constantly  increase  in  tension  until  the 
elbow  is  reached,  when  the  bandage  is  pinned. 
The  spirals  may  converge  somewhat  on  the 
sound  side,  so  that  they  overlap  three-quar- 
ters (Fig.  31). 

Use. — To  force  the  head  of  the  humerus 
outwards.  This  is  done  by  the  action  of  the 
lower  spiral  turns.  These  being  applied  with 
more  tension  than  the  upper  ones  convert  the 
shaft  of  the  bone  into  a  lever,  the  fulcrum  of 
which  corresponds  to  the  pad. 


54 


BANDAGES    OF   THE   UPPER   EXTREMITY 


FIG.  31. 


Second  roller  of  Desault's  dressing. 


55 


THE   ROLLER   BANDAGE 


FIG.  32. 


Showing  the  manner  of  commencing  the  third  roller  of  Desault. 


BANDAGES   OF  THE   UPPER   EXTREMITY 

Third  Roller  of  Desault. 
2 '  i'  inches  by  7  yards. 

Place  the  initial  extremity  of  the  roller 
under  the  axilla  on  the  sound  side,  and  carry 
it  obliquely  across  the  front  of  the  chest  to 
the  middle  of  the  summit  of  the  shoulder  "on 
the  injured  side.  Down  behind  the  humerus, 
and  parallel  with  it,  to  the  elbow  ;  under  the 
latter,  and  across  the  front  of  the  chest  to  the 
axilla  on  the  sound  side,  where  the  initial  ex- 
tremity is  met  and  fixed  (Fig.  32).  The  roller 
now  passes  under  the  axilla,  obliquely  across 
the  back  to  the  middle  of  the  summit  of  the 
shoulder  on  the  injured  side.  Down  in  front 
of  the  humerus,  and  parallel  with  it  to  the 
elbow ;  under  the  elbow,  and  across  the  back 
to  the  axilla  on  the  sound  side,  which  com- 
pletes one  entire  turn, — an  anterior  and  a 
posterior  triangle  (Fig.  33).  From  this  point 
it  emerges;,  and  is  in  position  to  cross  the 
front  of  the  chest  to  the  shoulder  on  the  in- 
jured side  as  before,  and  descend  behind  the 

57 


THE   ROLLER   BANDAGE 

humerus,    and    pass    under   the    elbow,   back 
again  to  the  axilla.     Another  posterior  turn 

FIG.  33. 


Showing  the  manner  of  continuing  the  third  roller  of  Desault. 

is  then  made.     In  this  way  three  anterior  and 
three   posterior  triangles  are  formed,   which 

58 


BANDAGES  OF  THE  UPPER  EXTREMITY 

exactly  repeat  each  other,  and  the  end  of  the 
roller  is  pinned  at  any  point  in  front.     Each 

FIG.  34. 


Desault's  dressing  completed. 


intersection  also  must  be  secured  by  pins  or 
adhesive  plaster,  and  a  sling  to  support  the 

59 


THE   ROLLER   BANDAGE 

forearm    and    hand    completes    the    dressing 

(Fig-  34)- 

Use. — To  draw  the  shoulder  upwards  and 

backwards.  To  accomplish  this,  it  is  evident 
that  the  posterior  turns  must  be  applied  with 
more  tension  than  the  anterior. 

The  bandage  of  Desault  as  a  whole  is  em- 
ployed usually  for  fracture  of  the  clavicle. 
Portions  of  the  dressing  are,  however,  fre- 
quently used  for  other  purposes ;  the  second 
roller  being  applied  when  it  becomes  neces- 
sary to  retain  the  arm  to  the  side  of  the  body 
for  any  cause,  as  in  fracture  of  the  humerus. 
The  third  roller  may  be  used  after  dislocation 
of  the  head  of  the  humerus  or  of  the  acro- 
mial  end  of  the  clavicle. 


60 


BANDAGES    OF   THE   UPPER   EXTREMITY 

Third  Roller  of  Desault  Modified  by  the 
Author. 

In  order  to  obtain  a  more  direct  elevating 
force,  the  third  roller  may  be  applied  as 
shown  in  Fig.  35.  To  do  this,  place  the 
initial  extremity  under  the  sound  axilla,  carry 
the  roller  obliquely  across  the  front  of  the 
chest  to  the  shoulder  on  the  injured  side, 
down  behind  the  arm  and  parallel  to  it,  and 
under  the  elbow,  as  in  Desault.  From  the 
elbow  the  roller  ascends  obliquely  across  the 
forearm  and  front  of  the  chest  to  the  summit 
of  the  shoulder  on  the  sound  side,  and  down 
obliquely  across  the  back  to  the  elbow  on  the 
injured  side.  Thence  it  ascends  the  arm  to 
the  shoulder  on  the  injured  side,  and  returns 
across  the  back  to  the  axilla  on  the  sound 
side.  Here  it  fixes  the  initial  extremity,  and 
two  more  similar  turns  are  made,  which  ex- 
actly repeat  each  other,  when  the  terminal 
end  is  secured  as  in  the  original  bandage. 
The  anterior  turns  applied  in  this  way  lose 

61 


THE   ROLLER   BANDAGE 

to  a  great  extent  their  power  to  draw  the 
shoulder  forward.     The  necessary  precaution, 


FIG.  35. 


Third  roller  of  Desault  as  modified  by  the  author. 

to  use  more  tension  for  the  posterior  than  the 

anterior  turns,  when  the  roller  is  applied  in 

62 


BANDAGES  OF  THE  UPPER  EXTREMITY 

the  ordinary  way,  is  therefore  not  required, 
as  the  direction  of  the  forces  and  their  rela- 
tive points  of  application  are  of  themselves 
sufficient  to  effect  this  result,  besides  gaining 
a  greater  elevating  force. 


Velpeau's  Bandage. 

2 ' .-  inches  by  14  yards  (two  seven-yard  rollers). 

Having  placed  the  hand  of  the  injured  side 
upon  the  sound  shoulder,  the  initial  extremity 
is  started  over  the  spine  of  the  scapula  on 
the  sound  side,  and  the  roller  carried  across 
the  back  to  the  injured  side,  pursuing  the  fol- 
lowing course  :  the  middle  of  the  summit  of 
the  shoulder  ;  the  middle  of  the  outer  aspect 
of  the  arm,  behind  the  elbow,  across  to  the 
axilla  on  the  sound  side,  and  under  it  to 
the  starting-point.  Repeat  this  turn  to  fix 
the  bandage  (Fig.  36).  On  reaching  the 
scapula  the  second  time,  make  a  circular 
turn  around  the  thorax,  including  in  it  the 
arm  on  the  injured  side.  The  external  con- 

63 


THE   ROLLER   BANDAGE 


FIG.  36. 


Showing  the  manner  of  commencing  Velpeau's  bandage. 


64 


BANDAGES   OF  THE   UPPER   EXTREMITY 

dyle  of   the  humerus  being   the    point  over 
which  the  middle  of  the  roller  passes  (Fig. 

FIG.  37. 


Showing  the  course  of  the  first  spiral  turn  of  Velpeau's  bandage. 


37),   on  its  way  back   to   the  starting-point. 
A  shoulder  turn   is   now   made,   which  over- 
laps the  fixing   turn    three-quarters   towards 
s  65 


THE    ROLLER   BANDAGE 

the  median  line  of  the  body.  Then  another 
circular  (ascending  spiral)  turn  overlapping  the 
preceding  turn  one-half.  So,  shoulder  turns 

FIG.  38. 


bandage  completed. 


and  spiral  turns  alternate  until  the  former 
support  the  point  of  the  elbow.  After  this 
spiral  turns  alone  are  continued,  until  the 
entire  extremity  up  to  the  wrist  is  thoroughly 


66 


BANDAGES  OF  THE  UPPER  EXTREMITY 

supported.  No  sling  is  used  in  this  dressing. 
Pins  or  adhesive  plaster  must  be  freely  used 
over  the  shoulder  and  about  the  elbow  (Fig. 

38). 

Uses. — Fracture  of  the  clavicle,  and  after 
dislocation  of  the  humerus.  The  point  of 
the  elbow  should  be  carefully  protected  from 
pressure  by  a  perforated  lint  pad. 


Figure -of -Eight  Bandage  of  the  Neck  and 
Axilla. 

2  inches  by  4  yards. 

Fix  the  initial  extremity  by  circular  turns 
around  the  neck.  Descend  from  the  neck 
to  the  axilla,  carrying  the  roller  from  before 
backwards,  if  the  right  axilla  is  to  be  in- 
cluded, and  from  behind  forwards,  if  the  left. 
Pass  under  the  axilla,  ascend  to  the  neck, 
and  encircle  it.  So  alternate  between  neck, 
and  axillary  turns,  until  three  have  been 
made,  either  repeating  one  another,  or,  as 

67 


THE   ROLLER  BANDAGE 

shown  in  Fig.  39,  overlapping  three-quarters. 
It  may  be  terminated  and  secured  at  any 
point  the  roller  runs  out. 

FIG.  39. 


Figure-of-eight  bandage  of  the  neck  and  axilla. 

Uses. — To   retain    dressings    after    injuries 
and  operation  about  the  shoulder  and  axilla. 

68 


BANDAGES   OF   THE   UPPER   EXTREMITY 


Spica  Bandages  of  the  Shoulder. 

ASCENDING  SPICA. 

2)^  inches  by  7  yards. 

Fix  the  initial  extremity  slightly  above  the 
middle    of    the    arm    on    the    injured    side. 

FIG.  40. 


Showing  the  first  turn  of  the  ascending  spica  of  the  shoulder. 

Carry   the    roller    across    the    front    of    the 
chest  (if  the  right  is  the  injured  side,  across 

69 


THE   ROLLER   BANDAGE 

the  back  if  the  left)  to  the  opposite  axilla  ; 
passing-  under  this,  return  by  the  back  (or 
by  the  chest  if  the  left  side  is  being  band- 
aged) to  the  injured  side.  In  the  ascending 
spica  the  lower  border  of  the  roller  deter- 
mines the  position  of  the  spica.  This  turn, 
therefore,  should  cross  the  previous  turn,  so 
that  the  lower  borders  of  both  intersect  at  the 
outer  side  of  the  arm  (Fig.  40).  Encircle  the 
arm  and  overlap  ascending  two-thirds.  Pass 
to  the  opposite  axilla,  gradually  converging 
with  the  preceding  turn  so  that  at  this  point 
it  will  repeat  it.  So  alternate  between  body 
and  arm  turns  until  the  shoulder  is  covered, 
when  the  bandage  may  be  secured  by  a  pin 
at  any  convenient  point  (Fig.  41). 

Uses. — To  retain   dressings   and    splints  to 
the  shoulder. 


BANDAGES   OF   THE   UPPER   EXTREMITY 


FIG.  41. 


Ascending  spica  of  the  shoulde 


71 


THE   ROLLER  BANDAGE 


DESCENDING   SPICA. 

• 

2^  inches  by  7  yards. 

Fix  the  initial  extremity  to  the  upper  part 
of  the  arm.     Carry  the  roller  to  the  base  of 

FIG.  42. 


Showing  the  first  turn  of  the  descending  spica  of  the  shoulder. 

the  neck,  and  pass  across  the  front  of  the 
chest  (or  the  back,  if  the  left  side  is  being 
bandaged)  to  the  opposite  axilla.  Return 


BANDAGES   OF  THE   UPPER   EXTREMITY 

across  the  back  (or  front  of  the  chest,  if  the 
left  side)  to  the  base  of  the  neck  on  the 
injured  side.  In  the  descending  spica,  the 


FIG.  43. 


Descending  spica  of  the  shoulder. 

upper  border  of  the  bandage  determines  the 
position  of  the  spica.  The  upper  borders 
of  this  turn  and  the  preceding  one  should, 
therefore,  coincide  at  the  junction  of  the 
base  of  the  neck  and  summit  of  the  shoulder 

73 


THE   ROLLER   BANDAGE 

(Fig.  42).  Pass  under  the  axilla  on  the  in- 
jured side,  and  so  continue  overlapping  two- 
thirds  descending  at  the  spica  and  converging 
under  the  axilla  on  the  sound  side,  until  the 
shoulder  is  covered  (Fig.  43).  Pin  the  termi- 
nal extremity  at  the  spica,  or  at  any  conve- 
nient point. 

Uses. — To  retain  dressings  higher  up  on 
the  shoulder  than  can  be  neatly  done  by  the 
ascending  spica. 


Spiral   Reversed   Bandage   of  the   Upper 
Extremity. 

2>£  inches  by  7  yards. 

Fix  the  initial  extremity  at  the  wrist,  carry- 
ing the  roller  from  left  to  right  in  bandaging 
either  side.  Pass  across  the  back  of  the  hand 
(from  the  ulnar  to  the  radial  side,  if  the  right 
hand,  and  from  the  radial  to  the  ulnar,  if  the 
left)  to  the  tips  of  the  fingers  (Figs.  44  and  45). 
Here  make  a  circular  and  a  spiral  reversed 
turn.  Two  figure-of-eight  turns  above  and 

74 


BANDAGES   OF  THE   UPPER  EXTREMITY 

FIG.  44. 


Initial  turns  of  spiral  reversed  on  the  right  hand. 


FIG.  45. 


'  .jtfajfcr 


Initial  turns  of  spiral  reversed  on  the  left  hand. 

75 


THE   ROLLER   BANDAGE 

below  the  thumb  are  then  made  (Fig.  46), 
and  the  roller  is  carried  up  to  the  wrist.  Con- 
tinue up  the  forearm  with  spiral  turns  until  the 
diameter  of  the  latter  increases  sufficiently  to 

FIG.  46. 


Showing  figure-of-eight  turns  above  and  below  the  thumb. 

render  reverses  necessary  (Fig.  47).  Make 
these  until  a  point  near  the  elbow  is  reached, 
when  spiral  turns  take  their  place  until  the 

increasing    diameter    of    the    arm    requires 

76 


BANDAGES   OF   THE    UPPER   EXTREMITY 


FIG.  47. 


- 


Showing  the  point  at  which  reversing  begins. 


77 


THE    ROLLER   BANDAGE 


Spiral  reversed  bandage  of  the  upper  extremity  completed. 


BANDAGES  OF  THE  UPPER  EXTREMITY 

reversing  upon.  A  few  more  spiral  turns  com- 
plete the  bandage  (Fig.  48).  The  elbow  may 
be  covered  by  figure-of-eight  turns,  particu- 
larly if  the  forearm  is  to  be  retained  in  a  flexed 
position,  as  shown  in  Fig.  49,  and  presently 
to  be  described. 

Uses. — To  retain   dressings  and    splints  to 
the  part,  etc.    . 


Figure-of-eight  Bandage  of  the  Elbow. 

2  '  j  inches  by  2  yards. 

Fix  the  initial  extremity  by  circular  turns 
over  the  point  of  the  elbow.  After  reaching 
the  front  of  the  joint  the  third  time  carry  the 
roller  upwards,  so  that  a  turn  shall  be  made 
which  overlaps  the  fixing  turns  two-thirds 
ascending.  On  returning  to  the  front  of  the 
joint  carry  the  roller  downwards,  so  that  a 
turn  shall  be  made  which  overlaps  the  fixing 
turns  two-thirds  descending.  Thus  alternate 
above  and  below  the  joint  with  turns  which 
continue  to  diverge  from  the  olecranon,  but 

79 


THE   ROLLER   BANDAGE 

overlap  (approximately)  in  front  of  the  elbow, 
until  four  or  five  complete  figures-of-eight 
have  been  made,  when  the  terminal  extremity 
is  pinned  at  the  front  (Fig.  49). 


FIG.  49. 


Figure-of-eight  bandage  of  the  elbow. 


Uses. — To  retain  dressings  and  as  part  of 
the  spiral  reversed  bandage  of  the  upper  ex- 
tremity. 


80 


BANDAGES   OF   THE   UPPER   EXTREMITY 


Spica  Bandage  of  the  Thumb. 

ASCENDING  SPICA. 

I  inch  by  3  yards. 

Fix  the  initial  extremity  at  the  wrist,  carry 
the  roller  to  the  tip  of  the  thumb,  and  make  a 

FIG.  50. 


Ascending-  spica  of  the  thumb. 

circular  turn.  Make  a  series  of  figure-of- 
eight  turns  of  the  thumb  and  wrist,  over- 
lapping (ascending)  two-thirds  ;  the  intersec- 
tions, or  spicas,  being  made  over  the  dorsum 

6  81 


THE   ROLLER   BANDAGE 

of  the  thumb  (Fig.  50).     Pin  the  terminal  end 
at  the  wrist. 

Uses. — To  retain  dressings   and  splints    to 
the  part. 

DESCENDING   SPICA. 

I  inch  by  3  yards. 

Fix  the  initial  extremity  at  the  wrist,  carry 
the  roller  to  the  metacarpo-phalangeal   joint 


Descending  spica  of  the  thumb. 


of  the  thumb,  and  make  a  circular  turn.     Re- 
turn to  the  wrist,  and,  with  alternating  thumb, 


BANDAGES  OF  THE  UPPER  EXTREMITY 

and  wrist  turns  which  overlap  two-thirds,  de- 
scend towards  the  tip  of  the  thumb.  Here 
also  each  spica  should  be  made  over  the 
dorsum  of  the  thumb.  The  terminal  end  is 
secured  at  the  wrist  (Fig.  51). 

Uses. — To  retain  dressings,  and  after  luxa- 
tion of  the  base  of  the  metacarpal  bone  of 
the  thumb. 


Gauntlet  Bandage. 

I  inch  by  5  yards. 

Fix  the  initial  extremity  at  the  wrist,  and 
carry  the  roller  abruptly  across  the  back  of 
the  hand  to  the  tip  of  the  index  finger  (if  the 
right  hand,  to  the  tip  of  the  little  finger  if  the 
left),  and  make  a  circular  turn,  after  which 
the  finger  is  ascended  by  a  series  of  spiral 
turns.  Some  reverses  may  be  necessary  if  the 
fingers  are  cedematous,  or  if  a  very  bulky 
dressing  is  to  be  retained,  but  ordinarily  none. 
When  the  finger  is  covered,  pass  across  the 
back  of  the  hand  to  the  wrist,  and  there  make 

83 


THE    ROLLER   BANDAGE 

another  circular  turn.     In   like  manner  each 
finger   is   bandaged,   and   finally  the    thumb, 

FIG.  52. 


Gauntlet  bandage. 

when  the  terminal  end  is  pinned  at  the  wrist 

(Fig-  52). 

Uses. — To  retain  dressings  after  burns  and 
scalds.  To  apply  splints.  One  or  two  fingers 
only  are  generally  covered,  the  dressing  as  a 
whole  being  seldom  used. 

84 


BANDAGES    OF   THE    UPPER    EXTREMITY 


Demi-Gauntlet  Bandage. 

I  inch  by  3  yards. 

Fix  the  initial  extremity  at  the  wrist.     Carry 
the  roller  across  the  back  of  the  hand  to  the 

FIG.  53. 


Demi-gauntlet  bandage. 


base  of  the  index  finger  (if  the  right  hand, 
to  the  base  of  the  little  finger  if  the  left), 

85 


THE   ROLLER   BANDAGE 

encircle  this,  and  return  in  the  opposite  direc- 
tion across  the  back  of  the  hand  to  the  wrist. 
So  continue  until  all  the  fingers  have  had  this 
loop  thrown  over  them,  including  finally  the 
thumb,  when  the  terminal  extremity  is  pinned 
at  the  wrist  (Fig.  53).  Here,  as  in  the  gaunt- 
let, it  is  better  to  make  a  complete  circular 
turn  of  the  wrist  after  each  finger  is  covered. 
Uses. — To  retain  light  dressings  to  the  dor- 
sum  of  the  hand. 


86 


Bandages  of  the  Trunk. 


Spiral  Bandage  of  the  Chest. 

3  inches  by  7  yards. 

Fix   the    initial   extremity  about  the  waist. 

FIG.  54. 


Spiral  bandage  of  the  chest. 


Ascend  the  chest  by  spiral  turns,  overlap- 
87 


THE   ROLLER   BANDAGE 

ping  one-half,  until  a  point  just  below  the 
level  of  the  axillae  is  reached.  At  the  spine, 
recur  across  the  left  shoulder  to  the  sternum, 
and  back  across  the  right  shoulder  to  the 
spine.  Secure  each  recurrent  with  a  pin 

(Fig-  54). 

Uses. — To  support  the  chest,  as  after  frac- 
ture of  the  ribs,  or  to  retain  dressings  to  it. 


Anterior  Figure-of-£ight  Bandage  of  the 
Chest. 

2^  inches  by  7  yards. 

Fix  the  initial  extremity  on  the  upper  part 
of  the  right  arm,  and  carry  the  roller  across 
the  shoulder  and  front  of  the  chest  to  the  left 
axilla.  Pass  under  this,  over  the  -left  shoul- 
der, and  across  the  front  of  the  chest  to  the 
right  axilla.  Encircle  the  right  shoulder  from 
below  upwards,  and  return  to  the  left  side  as 
before.  So  proceed  until  three  or  four  turns 
have  been  made.  These  may  repeat  one  an- 
other throughout,  or  may  overlap  three-quar- 

88 


BANDAGES    OF   THE   TRUNK 

ters  over  the  sternum.     The  terminal  end  is 
secured   at   any   convenient    point    in    front 

(Fig-  55). 


FIG.  55. 


Anterior  figure-of-eight  of  the  chest. 


Uses. — To  draw  the  shoulders  together  an- 
teriorly, and  to  retain  dressings. 


89 


THE    ROLLER   BANDAGE 

Posterior  Figure -of -Eight  Bandage  of  the 
Chest. 

2>£  inches  by  7  yards. 

Fix  the  initial  extremity  on  the  upper  part 
of  the   left   arm.     Carry  the    roller  over  the 

FIG.  56. 


summit  of  the  left  shoulder,  and  across  the 
back  to  the  right  axilla.     Passing  under  this, 


90 


BANDAGES   OF   THE   TRUNK 

and  to  the  summit  of  the  shoulder,  again  cross 
the  back  to  the  left  axilla,  where  the  left  shoul- 
der is  encircled  in  a  similar  manner.  After 
making  four  or  five  of  these  turns,  pin  the 
terminal  end  in  front.  Each  turn  may  repeat 
throughout,  or  overlap  over  the  spine  three- 
quarters,  as  shown  in  Fig.  56. 

Uses. — To  draw  the  shoulders  together  pos- 
teriorly, and  to  retain  dressings  over  the 
upper  part  of  the  back. 


Spied,  Suspensory  Bandages  of  the  Breast. 

SINGLE  SPICA. 

2^4  inches  by  7  yards. 

Place  the  initial  extremity  on  the  scapula 
upon  the  affected  side.  Carry  the  roller  across 
the  back  to  the  summit  of  the  opposite  shoul- 
der, and  thence  down  under  the  lower  portion 
of  the  affected  breast,  beneath  the  axilla,  to 
the  starting-point.  Repeat  this  turn  (Fig.  57) 
to  fix  the  initial  extremity.  On  reaching  the 
scapula  the  second  time,  make  the  first  circular 

91 


THE    ROLLER   BANDAGE 

turn  around  the  chest.  This  should  pass 
under  the  sound  breast  and  across  the  lower 
border  of  the  affected  breast.  Having  com- 

FIG.  57. 


Initial  turn  of  suspensory  of  tV.e  breast. 

pleted  this  circular,  another  shoulder  turn  is 
made,  which  overlaps  the  previous  one  three- 
quarters,  ascending.  Then  another  circular, 

which1  overlaps    the   preceding   circular   one- 

92 


BANDAGES   OF  THE  TRUNK 

half  over  the  affected  breast,  three-quarters 
under  the  sound  breast.  So  shoulder  turns 
and  circulars  alternate,  until  the  breast  is 

FIG.  58. 


\ 


Single  spica  or  suspensory  of  the  breast. 

thoroughly  supported,  when  the  terminal  end 
may  be  pinned  at  any  point  in  front  (Fig.  58). 
Uses. — To  retain  dressings  to  the  part.     To 
give  support  or  compression. 

93 


THE   ROLLER   BANDAGE 


Double  Spica. 

2'2  inches  by  10  yards. 

The    initial  extremity  is  fixed  in  the  same 
way  as  in  applying-  the  single  spica.    (Fig.  57). 

FIG.  59. 


Initial  turns  of  double  spica  of  the  breast. 

On  reaching  the  left  scapula  the  second  time, 
carry  the  roller  straight  across  the  back  to  the 
right  scapula,  under  the  axilla  and  right  breast 

94 


BANDAGES   OF   THE   TRUNK 

to  the  opposite  shoulder.  Passing  from  here 
to  the  right  scapula,  the  first  circular  turn  be- 
gins. It  should  encircle  the  chest  on  a  line 
that  will  include  the  lower  border  of  both 

FIG.  60. 


Double  spica  or  suspensory  of  the  breast. 

breasts  (Fig.  59).  When  this  turn  is  com- 
pleted, the  roller  passes  to  the  summit  of  the 
right  shoulder,  and  descends  to  include  the 
left  breast.  Again  it  is  carried  across  the 

95 


THE   ROLLER   BANDAGE 

back,  under  the  right  axilla,  and  ascends,  in- 
cluding the  right  breast,  to  the  left  shoulder. 
Then  a  second  circular  turn  is  made.  In 
this  way  left  breast,  right  breast,  and  circular 
turns  alternate,  the  two  former  overlapping 
two-thirds,  the  latter  one-half,  until  both 
breasts  are  covered.  Three  series  of  spicas 
are  thus  formed, — one  over  the  sternum  and 
one  under  each  breast  (Fig.  60).  The  termi- 
nal extremity  may  be  pinned  at  any  point  in 
front. 

Uses. — To  retain  dressings,  and  to  give  sup 
port  or  pressure  to  both  mammae. 


96 


Bandages  of  the  Lower  Extremity. 


Single  SpicA  Bandage  of  the  Groin. 

2j^  inches  by  7  yards. 
ASCENDING  SPICA. 

Fix  the  initial  extremity  about  the  upper 
part  of  the  thigh,  and  carry  the  roller  across 
the  pubis  to  the  crest  of  the  ilium  on  the  op- 
posite side  (if  the  right  groin,  while  if  the  left 
the  roller  is  carried  first  to  the  crest  of  the 
ilium  on  the  affected  side).  Thence  around 
the  body,  return  to  the  starting-point  and 
encircle  the  thigh.  As  the  lower  border 
of  the  roller  in  each  turn  determines  the 
position  of  the  spica,  it  should  intersect 
directly  in  front  of  the  thigh  and  the  roller 
be  made  to  overlap  two-thirds,  ascending 
(Fig.  61).  On  crossing  the  pubis  a  second 
time  the  roller  is  made  to  converge  towards 

7  97 


THE   ROLLER    BANDAGE 

the  former  turn,  so  that  when  it  reaches 
the  crest  of  the  ilium  it  will  repeat  it.  Pro- 
ceed again  to  the  thigh,  and  so  continue  until 

FIG.  61. 


Initial  turns  of  the  ascending  spica  of  the  groin. 


the  bandage  is   exhausted.     In   securing  the 
terminal  end,   thrust   the  pin    in   a    sufficient 

depth  to  include  any  dressing  which  may  have 

98 


BANDAGES  OF   THE   LOWER   EXTREMITY 

been  applied,  as  the  latter  is  very  liable  to 
become  displaced  (Fig.  62). 


FIG.  62. 


Ascending  spica  of  the  groin. 


Uses. — To  retain  dressings  to  the  groin, 
and  to  complete  the  application  of  splints  to 
the  thigh. 


99 


THE   ROLLER   BANDAGE 
DESCENDING   SPICA. 

Fix  the  initial  extremity  at  the  uppermost 
portion  of  the  thigh.     Carry  the  roller  across 


Fu;.  63. 


Initial  turns  of  the  descending  spica  of  the  groin. 


the  highest  part  of  the  abdomen  which  it  is 
intended  to  cover,  and  proceed  across  the 
back  to  the  groin  In  this  bandage  the  upper 


BANDAGES   OF  THE   LOWER   EXTREMITY 

border  of  the  roller  forms  the  spica  ;  this  turn, 
therefore,  must  cross  the  preceding  one  so 
that  their  upper  borders  coincide  directly  in 
front  (Fig.  63).  Encircle  the  thigh,  overlap- 


Descending  spica  of  the  groin  completed. 


ping,  descending,  two-thirds.  Pass  the  roller 
across  the  abdomen  and  make  it  converge 
towards  the  former  turn,  so  that  when  the 


101 


THE   ROLLER   BANDAGE 

opposite  side  is  reached  it  will  repeat  it,  when 
it  at  once  begins  to  diverge  towards  the  groin. 
So  continue  until  the  roller  runs  out,  when 
the  terminal  end  is  pinned  deeply  over  the 
spica  (Fig.  64). 

Uses. — The  same  as  the  preceding  bandage. 
It  is  often  not  decided  which  of  these  to  apply 
until  after  the  first  turn  is  made,  when  it  may 
seem  desirable  to  extend  the  turns  above  or 
below  the  starting-point. 


Double  Spica  Bandage  of  the  Groin. 

2  ' ..  inches  by  10  yards. 
ASCENDING   SPICA. 

Fix  the  initial  extremity  upon  the  upper 
portion  of  the  right  thigh,  or  retain  it  with  the 
thumb  of  the  left  hand  until  the  first  turn  is 
made  (the  latter  economizes  the  bandage). 
After  encircling  the  thigh,  carry  the  roller 
across  the  pubis  to  the  left  iliac  crest  and 
directly  across  the  back  to  the  corresponding 
point  on  the  right  side.  Passing  over  the 


102 


BANDAGES   OF  THE   LOWER   EXTREMITY 

pubis  again,  encircle  the  left  thigh,  and  re- 
turn by  the  back  to  the  starting-point  in 
front  of  the  right  thigh  (Fig.  65).  Three 


FIG.  65. 


Initial  turns  of  the  double  ascending  spica  of  the  groin. 


spicas  are  begun  in  the  first  series  of  turns, 
and  as  each  intersection  of  the  lower  border 
of  the  roller  determines  the  location  of  these 

spicas,  each  must  be  made  in  its  proper  place 

103 


THE   ROLLER   BANDAGE 

respectively  in  the  median  line  of  the  abdo- 
men and  directly  in  front  of  each  thigh.  So 
continue  overlapping  two-thirds,  ascending  in 


Fu;.  66 


Double  ascending  spica  of  the  groin. 


front  and  repeating  behind,  in  the  order  right 
thigh,  body,  left  thigh,  body,  right  thigh,  etc., 
until  three  or  four  complete  turns  have  been 
made,  when  the  terminal  end  may  be  pinned 

over  a  spica  (Fig.  66). 

104 


BANDAGES    OF   THE   LOWER   EXTREMITY 


Uses. — To  retain  double  hernia.     To  make 
pressure  or  apply  dressings  to  both  groins. 

DESCENDING    SPICA. 

Fix  the  initial  extremity  on  the  uppermost 
portion  of  the  right  thigh,  or  retain  it  with  the 

FIG.  67. 


Initial  turns  of  the  double  descending  spica  ot  the  groin. 


thumb  of  the  left  hand  until  the  first  turn  is 
made.     Having  encircled  the  thigh,  carry  the 


I  OS 


THE   ROLLER   BANDAGE 

roller  across  the  highest  part  of  the  abdomen, 
which  is  to  be  covered,  to  the  opposite  side. 
Cross  the  back  horizontally,  and  descend  over 


FIG.  68 


Double  descending  spica  of  the  groin. 


the  abdomen  to  the  left  thigh,  and  encircle  it. 
Convey  the  roller  again  across  the  back,  de- 
scending on  the  right  side  to  the  starting- 
point  over  the  right  thigh  (Fig.  67).  Here, 


1 06 


BANDAGES   OF   THE   LOWER   EXTREMITY 

as  in  the  preceding  dressing,  there  are  to  be 
three  spicas.  The  intersection  of  the  upper 
border  of  the  roller  in  the  median  line  and  in 
front  of  each  thigh  determines,  therefore,  the 
position  of  each  spica.  So  proceed,  over- 
lapping two-thirds,  descending  in  the  order 
just  described  for  the  ascending  spica,  until 
three  or  four  complete  turns  have  been  made, 
when  the  terminal  extremity  may  be  pinned 
over  either  spica  (Fig.  68). 

Uses. — The  same  as  the  preceding  bandage. 
Whether  to  employ  one  or  the  other  is  often 
decided,  as  in  the  single  spica,  after  the  first 
turn  is  made. 


Figure-of-eight  Bandage  of  the  Knee. 

2 ' ;  inches  by  2  yards. 

Fix  the  initial  extremity  by  circular  turns 
over  the  patella.  On  reaching  the  popliteal 
space  the  third  time  carry  the  roller  upwards, 
so  that  a  turn  shall  be  made  which  overlaps 
the  fixing  turns  two-thirds,  ascending.  On 
returning  to  the  back  of  the  joint  carry  the 

107 


THE    ROLLER   BANDAGE 

roller  downwards,  so  that  a  turn  shall  be  made 
which  overlaps  the  fixing  turns  two-thirds,  de- 
scending. Thus  alternate  above  and  below 
the  joint  with  turns  which  continue  to  diverge 
from  the  patella,  but  overlap  (approximately) 
at  the  popliteal  space  until  three  complete  fig- 
ures-of-eight  have  been  made,  when  the  termi- 
nal extremity  is  pinned  at  any  point  (Fig.  69). 

FIG.  69. 

, 


Figure-of-eight  bandage  of  the  knee. 

When  this  bandage  is  used  as  a  part  of  the 
spiral  reversed  of  the  lower  extremity,  a  slight 
modification  in  the  lay  of  the  initial  and  ter- 
minal turns  becomes  necessary. 

108 


Uses. — To  retain  splints  and  dressings  to  the 
knee-joint,  and  as  a  part  of  the  spiral  reversed 
bandage  of  the  lower  extremity. 


Spica  Bandage  of  the  Foot. 

I]/!  inches  by  3  yards,  for  the  foot  alone. 

Fix  the  initial  extremity  at  the  ankle,  and 
convey  the  roller  abruptly  across  the  dorsum 
of  the  foot  to  the  base  of  the  toes.  Around 
the  foot  at  this  point  make  a  circular  turn, 
then  a  spiral,  and  proceed  to  the  heel.  The 
roller  crosses  the  latter  at  a  point  which  will 
bring  its  lower  border  on  a  level  with  the  sole 
of  the  foot.  Thence  return  across  the  dor- 
sum  and  make  the  first  spica.  The  lower 
border  of  the  roller  being  the  guide  for  the 
proper  location  of  the  spica  turns  (as  this  is 
an  ascending  spica),  it  must  intersect  the 
lower  border  of  the  preceding  turn  in  the 
median  line  of  the  foot  and  overlap  three- 
quarters,  ascending.  Unlike  all  other  spicas, 

this  -ascending  overlap  does  not  converge  at 

109 


THE   ROLLER   BANDAGE 


any  point,  but  continues  a  three-quarter  over- 
lap throughout  the  entire  course  of  each  turn, 
behind  the  heel,  as  well  as  around  the  foot. 
Another  foot  turn  being  completed,  the  roller 
is  carried  to  the  heel.  So  foot,  and  heel  turns 
alternate  until  the  former  is  completely  cov- 
ered, and  the  latter,  except  at  its  point  (Fig. 


FIG.  70. 


Spica  bandage  of  the  foot. 

70).  The  terminal  end  may  be  pinned  at  any 
convenient  point,  or  the  bandage  continued 
up  the  leg. 

Uses. — To  retain  dressings  to  any  part  of 
the  foot.     To  make  pressure  or  give  support. 


no 


BANDAGES  OF  THE  LOWER  EXTREMITY 

Also  to  commence  the  spiral  reversed  bandage 
of  the  lower  extremity. 


Incomplete  Bandage  of  the  Foot. 

2_^  inches  by  2  ya»rds,  for  the  foot  alone. 

Fix  the  initial  extremity  at  the  ankle,  and 
carry  the  roller  across  the  dorsum  of  the  foot, 

FIG.  71. 


Initial  turns  of  the  incomplete  bandage  of  the  foot. 

as  in  the  preceding  dressing.     Make  one  cir- 
cular, one  spiral,  and  one  spiral  reversed  turn 


THE   ROLLER   BANDAGE 

around  the  foot,  overlapping  two-thirds,  as- 
cending (Fig.  71),  and  proceed  across  the  in- 
step to  the  ankle.  Here  make  a  circular,  and 
again  crossing  the  instep,  make  another  foot 
turn.  The  ankle  and  foot  each  receive  an- 
other turn,  overlapping  the  preceding  one 

FIG.  72. 


The  incomplete  bandage  of  the  foot. 

two  thirds,  when  the  terminal  end  is  either 
pinned  at  the  ankle  or  the  roller  continued  up 
the  leg  (Fig.  72).  The  heel  is  not  covered. 

Uses. — To  retain  dressings,  and  to  com- 
mence the  spiral  reversed  bandage  of  the 
lower  extremity. 


112 


BANDAGES   OF  THE   LOWER   EXTREMITY 


Complete  Bandage  of  the  Foot. 

2 '  >  inches  by  3  yards,  for  the  foot  alone. 

Fix  the  initial  extremity  at  the  ankle,  carry 
the  roller  across  the  foot,  make  a  circular  turn, 


FIG.  73. 


Showing  the  heel  turn  in  the  complete  bandage  of  the  foot. 


a  spiral,  and  a  spiral  reversed,  all  as  in  the 
dressing  just  described.  Starting,  after  these 
turns  have  been  made,  at  the  instep,  carry  the 
roller  across  the  point  of  the  heel  and  back 
again  to  the  instep  (Fig.  73).  From  there 
8  113 


THE   ROLLER  BANDAGE 

pass  to  the  sole  of  the  foot,  and  around  the 
side  of  the  heel  under  the  malleolus  (the 
outer,  if  the  right  foot,  the  inner,  if  the  left), 
to  the  tendo  Achillis  (Fig.  74),  and  to  the 
instep.  Again  to  the  sole  of  the  foot,  beneath 

FIG.  74. 


Showing  the  inner  malleolar  turn  in  the  complete  bandage  of  the  foot. 

the  other  malleolus  to  the  tendo  Achillis,  and 
back  to  the  instep  (Fig.  75).  The  terminal 
extremity  is  either  pinned  here,  or  the  roller 
carried  up  the  leg.  The  turns  under  each 
malleolus  must  also  be  pinned.  This  band- 
age covers  the  heel. 

114 


BANDAGES   OF    THE   LOWER    EXTREMITY 

Uses. — To  retain  dressings,  and  make  uni- 
form pressure  upon  the  ankle-joint.     Also  to 


FIG.  75. 


Showing  the  outer  malleolar  turn  in  the  complete  bandage  of  the  foot. 


commence  the  spiral  reversed  bandage  of  the 
lower  extremity. 


• 

THE   ROLLER   BANDAGE 

Spiral  Reversed  Bandage  of  the  Lower 
Extremity. 

2>£  inches  by  7  yards  to  the  knee,  14  yards  to  the  groin. 

Fix  the  initial  extremity,  and  cover  the  foot 
by  either  of  the  three  methods  above  de- 
scribed. After  the  foot  has  been  covered, 
proceed  with  spiral  turns,  overlapping  two- 
thirds  up  the  leg,  until  its  increasing  diameter 
necessitates  reverses.  After  which  spiral 
turns,  or  if  the  calf  be  very  much  swollen  or 
a  bulky  dressing  has  been  applied  to  it,  de- 
scending spiral  reverses,  continue  until  the 
knee  is  reached.  The  terminal  end  is  here 
pinned.  If  the  roller  is  to  be  carried  up  to 
the  groin,  figure-of-eight  turns  will  be  made  to 
cover  the  knee  (see  page  108),  and  spirals  and 
spiral  reverses,  as  indicated  by  the  contour  of 
the  limb,  will  complete  the  dressing  (Fig. 
76). 

Uses. — To  retain  dressings,  splints,  exten- 
sion apparatus  to  the  part,  and  to  give  sup- 
port for  various  conditions. 

116 


BANDAGES  OF  THE  LOWER  EXTREMITY 


FIG.  76. 


Spiral  reversed  bandage  of  the  lower  extremity. 


117 


T- Band  ages,  Slings,  Binders,  and  Knots. 


T-BANDAGES,  slings,  binders,  and  knots,  while 
not  always  made  of  the  roller  bandage,  may 


FIG.  77. 


Single  T -bandage. 


properly  be  described,  because  the  latter  may 
be    used   for  the  purposes  of  them  all  and 

118 


T-BANDAGES 

because  a  description  of  them  in  this  connection 
will  probably  best  demonstrate  the  principles 
of  their  mode  of  construction,  their  form,  and 
their  uses. 

T-Bandag'es. 

A  T-bandage  consists  of  two  rollers,  the 
one  a  single,  the  other  a  double  roller  sewn 

FIG.  78. 


Double  T-bandage. 

together  at  a  right  angle.  It  may  be  made  of 
any  material,  though  usually  of  gauze  or  mus- 
lin, and  the  two  rollers  composing  it  may  be 

of  equal  width,  as  shown  in  Fig.  77,  or  they 

119 


THE   ROLLER   BANDAGE 


FIG.  79. 


T-bandag;e  of  the  chest. 


T-BANDAGES 

may  vary  to  any  extent  in  all  their  dimensions. 
The  double  T- bandage,  seldom  used,  is  shown 
in  Fig.  78,  which,  like  Fig.  77,  represents  a 
bandage  made  of  gauze. 

The  T-Bandage  of  the  Chest.— The  T-band- 
age  of  the  chest  consists  of  a  double  roller,  fifty 
inches  long  by  ten  inches  wide,  to  the  middle 
of  which  is  sewn  at  a  right  angle  a  single 
roller  thirty  inches  long  and  four  inches  wide. 
The  broad  portion  is  applied  to  the  chest,  and 
being  drawn  to  the  state  of  tension  desired,  is 
retained  in  position  by  safety-pins  neatly  in- 
serted at  regular  intervals.  The  narrow  strip 
is  then  carried  over  the  shoulder  and  fastened 
in  front  to  keep  the  chest  bandage  in  place. 
(Fig.  79.)  The  double  T-bandage  of  the 
chest  having  two  tails,  one  is  carried  over 
each  shoulder. 

The  T-Bandage  of  the  Pubis. — The  T-bandage 
of  the  pubis  consists  of  a  strip  of  muslin 
eighteen  inches  long  and  six  inches  wide,  to 
which  is  sewn  a  double-headed  roller  thirty 
inches  long  and  three  inches  wide.  The 

121 


THE   ROLLER   BANDAGE 


FIG.  80. 


f  the  pubis. 


122 


T-BANDAGES 

broad  portion  is  applied  to  the  pubis  and 
beneath  the  perineum,  while  the  narrow  band- 
age is  carried  around  the  lower  abdomen  and 
attached  to  the  extremity  of  the  broad  band- 
age over  the  sacrum.  (Fig.  80.)  It  may,  at 
times,  be  convenient  to  split  the  posterior 
portion  of  the  broad  bandage  into  two  tails 
three  inches  wide  in  order  to  attach  them  at 
the  loin  on  either  side  to  the  long  tails. 

The  T-Bandagc  of  the  Ear. — The  T-bandage 
of  the  ear  consists  of  a  double-headed  roller 
two  yards  long  and  one  inch  wide,  to  the 
middle  of  which  is  sewn  a  single  roller  one 
yard  long  and  one  inch  wide.  The  double- 
headed  roller  is  applied  to  the  vault  of  the 
cranium,  while  the  single  roller,  retaining  any 
dressing  applied  to  the  ear,  is  carried  verti- 
cally around  the  face. 

T-bandages  are  used  to  retain  light  dress- 
ings to  the  part. 

Other  T-bandages  may  take  the  place  of 
certain  slings  presently  to  be  described,  but 

the  latter  will  generally  be  found  more  useful. 

123 


THE   ROLLER   BANDAGE 

Slings. 

The  sling  most  commonly  used  is  that  to 
support    the    upper   extremity.      A   two-and- 

FIG.  8 1. 


Roller  bandage  sling  of  the  forearm. 


a-half-inch    roller    carried    around    the    neck 
and  wrist   is   given   a   hitch  just   above  the 

latter,   as  shown   in   Fig.   81.     The  ends  are 

124 


SLINGS 

then  drawn  upon  sufficiently  to  get  the  re- 
quired elevation  of  the  forearm,  when  they 
are  made  into  a  knot  which  includes  in  it  the 

FIG.  82. 


Handkerchief  sling  of  the  forearm. 


free  portion  of  the  roller.  This  sling  is  use- 
ful after  minor  injuries  of  the  fingers  and 
hand  and  to  keep  up  slight  restraint  of  the 

125 


THE   ROLLER   BANDAGE 

arm  after  splints  or  dressings  for  various  fract- 
ures and  dislocations  have  been  discarded,  but 
it  is  not  appropriate  for  the  support  of  heavy 


FIG.  83. 


Four-tailed  sling. 

splints  or  dressings,  as  the  weight  of  the  latter 
concentrates  the  pressure  too  much  at  the 
wrist.  For  these,  a  handkerchief  sling  made 

of  a  piece  of  muslin  one  yard  square,  folded 

126 


SLINGS 

diagonally  and  applied  as  shown  in  Fig.  82. 
gives  much  better  support  by  distributing  the 
pressure  throughout  the  whole  forearm. 

Four-Tailed  Sling. — This  can  be  quickly  made 
by  folding  a  strip  one  yard  long  of  a  two-and- 

FIG.  84. 


Four-tailed  sling  of  the  eye. 

a-half-inch  roller  and  scoring  it  with  scissors, 
as  shown  in  Fig.  83.  The  scored  portion  is 
then  torn  out,  leaving  four  tails  attached  to  the 
sling. 

127 


Four-Tailed  Sling  of  the  Eye. — Applying  the 
sling  to  a  dressing  of  the  eye,  the  upper  tails 
are  carried  around  the  head  above  the  ears 
and  tied  at  the  back,  while  the  lower  tails  are 
carried  below  the  ears  and  tied  also  at  the 
back  of  the  head,  as  shown  in  Fig.  84. 


FIG.  85. 


Four-tailed  sling  of  both  eyes. 


Four-Tailed   Sling   of    Both    Eyes. — For   this 
dressing  the  scoring  of  the  roller  is  done  at  a 

point  in  the  fold  which  will  make  a  sling  as  long 

128 


SLINGS 

again  as  that  required  for  one  eye.  The  sling 
is  applied  to  both  eyes,  the  upper  tails  being  car- 
ried above  the  ears  and  the  lower  tails  beneath 
the  ears  and  all  tied  at  the  back  of  the  head. 
(Fig-  85.) 

V      B       D  '  FIG.  86. 


Four-tailed  sling  of  the  ear. 

Four-Tailed  Sling  of  the  Ear,  prepared  as  the 
sling  for  one  eye,  retains  a  dressing  upon  the 
ear.  The  upper  tails  are  carried  around  the 

head  and  crossing  one  another  on  the  opposite 
9  129 


THE    ROLLER    BANDAGE 

side  are  brought  back  around  the  neck  and 
made  into  a  knot,  while  the  two  lower  tails 
are  carried  abruptly  down  to  the  neck  and 
tied  to  the  former,  as  shown  in  Fig".  86. 

Four-Tailed  Sling  of  the  Chin. — This  is  pre- 
pared by  scoring  the  folded   roller  to  make 


FIG.  87- 


Four-tailed  sling  ot'  the  chin. 


the  tails,  and,  at  the  same  time,  snipping  the 
corner  of  the  fold  out  with  the  scissors,  in 
order  to  leave  a  hole  in  the  centre  of  the 
sling.  Placing  the  sling  upon  the  chin,  the 

130 


BINDERS 

upper  tails  are  carried  along  the  jaw  on 
either  side  and  tied  at  the  back  of  the  neck, 
while  the  lower  tails  ascending  the  sides  of 
the  face  are  first  tied  at  the  vertex,  and,  after 
continuing  as  one  from  the  knot,  are  fastened 
at  any  convenient  point  to  the  other  tails,  as 
shown  in  Fig.  87.  This  is  a  useful  dressing 
to  limit  the  movements  of  the  inferior  max- 
illary after  dislocation  and  to  retain  dressings. 


Binders. 

Instead  of  a  single  bit  of  broad  muslin, 
pinned  or  otherwise  fastened  to  give  sup- 
port or  retain  dressings  to  a  part,  strips  of 
roller  may  be  sewn  together  at  their  edges, 
leaving  their  ends  free  and  thus  forming  a 
many-tailed  sling.  The  binder  or  sling  thus 
made  is  seldom  used  except  for  the  abdomen, 
though  it  may  be  adapted  for  other  purposes. 
The  binder  used  after  all  abdominal  opera- 
tions is  usually  made  of  canton  flannel,  each 
strip  being  one  yard-and-a-half  long  and 
four  inches  wide.  Six  of  these,  spread  out 

131 


THE   ROLLER   BANDAGE 

smoothly  upon  a  table  so  that  they  shall  over- 
lap one  another  one-half  of  their  width,  are 
sewn  together  at  their  middle  third  by  a  cat- 
stitch,  as  shown  in  Fig.  88. 

Their  free  ends  are  rolled  upon  strips  of 
cardboard   into   a    compact   form    which   can 

FIG.  88. 


Many-tailed  binder. 

easily  be  slipped  under  the  patient.  The  re- 
production represents  the  tails  on  the  right 
partially  rolled  upon  the  strip  of  cardboard. 
The  binder  is  applied  by  inserting  one  roll 
beneath  the  back  as  the  patient  lies  in  bed 
and  unrolling  the  tails  on  either  side.  The 
uppermost  pair  of  tails  is  carried  across  the 


BINDERS 


Method  of  applying  the  binder. 


133 


THE    ROLLER   BANDAGE 

lower  portion  of  the  chest  in  opposite  direc- 
tions and  held  in  place  by  the  hands  of  an 
assistant  while  the  next  two  lower  tails  are 
being  similarly  applied.  (Fig.  89.)  So  each 
pair  of  tails  in  turn  is  adjusted  until  the  low- 
est one  is  finished,  when  it  is  fastened  with  a 
safety-pin.  At  times  it  may  be  necessary  to 
pin  each  tail  if  very  firm  support  is  required. 


Knots. 

Various  knots,   usually  made  in   the  form 

FIG.  90. 


Double  half-hitch  of  roller  bandage. 

of  a  double  half-hitch,  are  occasionally  used  for 
the  purposes  of  temporary  traction  or  exten- 

134 


KNOTS 

sion.  They  may  be  made  of  a  bit  of  roller 
bandage  (Fig.  90),  of  a  handkerchief,  or  of  a 
sheet  (Fig.  91).  When  it  is  desired  to  use 

FIG.  91. 


Double  half-hitch  of  a  sheet. 


forcible  traction  in  efforts  at  reduction  of  dis- 
locations of  the  hip-joint  or  of  old  dislocations 
of  the  shoulder-Joint,  one  sheet  is  thus  knotted 
at  the  ankle  or  wrist,  while  another  passed 


THE   ROLLER   BANDAGE 

over  one  shoulder  and  under  the  other  arm 
of  the  operator  is  tied  through  a  loop  made 
of  the  tails  of  the  first  sheet.  A  slight  modi- 
fication of  such  a  hitch  is  a  convenient  form 

FIG.  92. 


Ankle  hitch  for  temporary  extension. 


of  making  moderate  extension  on  the  foot, 
but  the  pressure  is  too  much  concentrated 
behind  the  ankle  and  at  the  instep  to  allow  of 
much  weight.  This  knot  is  shown  in  Fig.  92. 


136 


Plaster-of-Paris  Bandages. 


THESE  are  best  prepared  in  the  following 
manner :  Cut  crinoline  with  scissors  into 
strips  seven  yards  long  and  two-and-a-half 

FIG.  93. 


Method  of  making  plaster  bandages. 

inches  wide,  and  roll  them  loosely  by  hand, 
with  the  key,  or  with  the  machine  (see 
page  13).  Unrolling  the  initial  extremity  of 
a  bandage  to  the  extent  of  one  yard,  spread 

137 


THE   ROLLER   BANDAGE 

upon  it  with  a  spatula  a  layer  of  dry  plaster- 
of-Pans  about  one-sixteenth  of  an  inch  thick, 
as  shown  in  Fig.  93.  This  portion  of  the 
bandage  is  firmly  rolled  so  that  it  will  retain 
as  much  of  the  plaster  as  possible  between 
its  layers.  Another  similar  length  is  then 
spread  and  rolled,  and  thus  the  process  is 
continued  with  the  whole  bandage.  A  rubber 
band  is  applied  to  retain  it,  it  is  wrapped  in 
wax  paper  to  exclude  moisture,  and  is  then 
ready  for  use. 

Method  of  Applying  the  Plaster-of-Paris  Band- 
age.— The  bandage  is  immersed,  standing  on 
end,  in  cold  water.  When  it  ceases  to  yield 
bubbles  of  air,  it  is  carefully  removed  from 
the  water  and  pressed  firmly  in  the  hand  to 
make  it  as  dry  as  possible.  It  is  then  ready 
to  be  applied. 

Mode  of  Application  of  Plaster-of-Paris  Band- 
ages.— Though  applied  for  other  purposes,  the 
plaster-of-Paris  bandage  has  these  three  uses 
to  which  it  is  most  commonly  put :  as  a  fixed 
dressing  after  fracture  of  the  leg  ;  as  a  dressing 

138 


FIXED   DRESSINGS 

to  immobilize  the  thigh,  the  hip-joint,  and 
the  pelvis  after  fracture,  or  in  the  treatment 
of  coxalgia ;  and  in  the  form  of  a  jacket 
applied  to  the  trunk  in  the  treatment  of 
diseases  of  the  spine. 

Application  of  Fixed  Dressings  to  the  Leg. — 
The  limb  should  be  perfectly  under  control 
while  the  plaster-of-Paris  is  being  applied. 
Three  trained  assistants  are  required,  one  to 
support  the  thigh,  another  to  support  the  leg 
and  foot,  and  the  third  to  assist  the  surgeon 
with  the  plaster  bandages  and  the  manipu- 
lation of  the  plaster-of-Paris.  If  so  much 
help  is  not  at  command,  some  device  which 
will  support  the  limb  in  proper  position  may 
be  used :  Two  uprights  (clothes-props),  at- 
tached vertically  to  the  head  and  foot  of  the 
bed,  are  joined  by  a  third  horizontal  bar  rest- 
ing upon  them  and  held  in  place  by  cord  or 
wire  nails.  The  patient  lies  in  bed  in  such  a 
position  that  the  fractured  leg  is  directly  be- 
neath the  horizontal  bar.  The  fractured  lea- 

o 

is  then   placed  upon  two  pillows,  which  will 

139 


THE    ROLLER   BANDAGE 

elevate  it  about  five  inches  from  the  bed, 
producing  thereby  slight  flexion  of  the  knee- 
joint.  Rubber  adhesive  suspension  straps 
are  then  applied  to  the  middle  of  the  thigh 
and  the  foot.  These  are  turned  upon  them- 
selves so  that  they  shall  form  a  loop  above 
through  which  a  cord  can  be  passed,  which, 
having  been  drawn  taut,  is  made  fast  to  the 
horizontal  bar.  On  removing  the  pillows,  the 
limb  may  be  found  sufficiently  supported.  If 
a  third  point  of  support  is  needed,  it  should 
be  in  the  form  of  a  prop  from  beneath  the 
limb  to  the  bed.  For  this  purpose  a  slender 
stick,  like  a  lead-pencil,  cut  to  the  proper 
length  and  padded  with  a  little  knob  of 
muslin,  is  placed  at  the  desired  point,  there 
to  remain  until  the  application  of  the  plaster- 
of-Paris  bandage  is  completed.  By  a  little 
experimental  slackening  and  tightening  of  the 
suspension  cords,  the  limb  will  finally  be  sus- 
pended in  a  very  correct  position  without  any 
manual  aid.  This  method  of  preparing  the 

leg  for  the  application  of  a  fixed  dressing  is 

140 


FIXED   DRESSINGS 


Method  of  suspending  a  fractured  leg  for  the  application  of  a  fixed  dressing. 


141 


THE   ROLLER   BANDAGE 

shown  in  Fig.  94.  Gentle  pressure  with  the 
finger  or  between  the  fingers  and  thumb  at 
some  point  where  slight  deformity  persists 
may,  at  times,  be  necessary  to  perfect  the 
modelling  process.  Having  applied  a  flannel 
bandage  from  the  foot  to  just  below  the  knee 
or  just  above  the  knee  according  to  the  point 
to  which  it  is  intended  that  the  dressing  shall 
reach,  the  plaster  bandages,  starting  from  the 
toes,  are  used  as  an  ordinary  roller,  except 
that  they  seldom  need  reversing. 

Having  applied  from  three  to  six  bandages, 
according  to  the  degree  of  firmness  required, 
free  plaster,  mixed  with  water  to  the  consist- 
ence of  thick  cream,  is  smoothly  spread  over 
the  dressing  with  the  hands,  thickly  enough 
to  completely  hide  the  turns  of  the  bandage. 
When  this  layer  has  begun  to  set,  a  very 
bright,  shining  surface  may  be  given  to  it  by 
rubbing  with  a  pad  of  cotton  saturated  with 
alcohol. 

In   the  use  of  plaster-of-Paris,   the   proper 

care  of  the  hands  should  not  be  overlooked. 

142 


FIXED    DRESSINGS 

A  little  vaseline  applied  in  and  around  the  nails 
facilitates  the  removal  of  the  plaster  from  the 
finger-tips,  while  the  unpleasant  harshness  of 
the  skin,  which  the  plaster  causes,  is  best  re- 
moved by  granulated  sugar.  The  latter  is 
used  by  simply  dissolving  it  upon  the  fingers 
with  plain  water. 

A  window  or  trap-door  in  a  plaster  of-Paris 
dressing,  in  order  to  give  access  to  a  wound, 
especially  one  of  compound  fracture,  may  be 
conveniently  made  in  the  following  manner  : 
A  half-inch  band  of  lead  tape  of  a  length 
equal  to  the  circumference  required  for  the 
window  is  formed  into  a  loop  or  ring  by 
closing  the  ends  together  with  a  bit  of  rubber 
adhesive  plaster.  This  is  applied  to  the  limb, 
and,  modelled  into  an  ellipse,  circle,  or  square, 
is  held  in  position  by  the  initial  flannel  band- 
age, which  also  retains  the  wound-dressing. 
After  the  plaster-of-Paris  has  set,  the  outline 
of  the. lead  wall,  being  distinctly  apparent,  is 
cut  down  upon  with  a  penknife,  except  at  one 
point  which  is  to  act  as  a  hinge,  and  the  lead 

143 


THE   ROLLER   BANDAGE 

band  removed,  as  shown  in  Fig.  95.  Beneath 
the  everted  flange-like  edge  of  the  window 
absorbent  cotton  should  be  inserted  in  order 
to  prevent  the  leakage  of  blood  or  pus  be- 
tween the  fixed  dressing  and  the  skin.  The 
trap  thus  formed  is  afterwards  kept  in  place 

FIG.  95. 


Showing  trap-door;  also  vertebrated  chain  employed  to  facilitate  the  removal  of 
the  fixed  dressing. 

by  a  bandage.  Should  the  window  exceed  in 
width  one  third  the  circumference  of  the  limb, 
the  dressing  may  be  reinforced  by  strips  of 
tin  laid  at  the  back  during  the  application  of 

the  plaster  bandages.     In  this  way  extensive 

144 


FIXED    DRESSINGS 

compound  fractures  of  the  leg  may  often  be 
appropriately  managed. 

Plastcr-of-Paris    Dressings    of   the    Hip. — The 

pelvis  may  be  elevated  from  the  bed  and  so 
held  by  the  hands  of  an  assistant,  or,  if  the 
patient  is  an  adult,  this  posture  may  be  con- 

FIG.  96. 


Pelvic  rest  used  for  the  application  of  a  fixed  dressing  to  the  hip. 

veniently  maintained  by  the  use  of  the  metallic 
rest,  as  shown  in  Fig.  96.  A  flannel  roller  in 
the  form  of  a  spica  of  the  groin  extended  well 
around  the  hip  and  including  the  buttock  is 
first  applied  in  order  to  protect  the  skin  from 
contact  with  the  plaster.  The  plaster  band- 
ages to  the  number  of  from  three  to  six,  accord- 

10  I45 


THE    ROLLER   BANDAGE 

ing  to  the  size  of  the  pelvis  and  the  require- 
ments of  firm  fixation,  are  applied  somewhat 
in  the  form  of  a  spica,  so  modified,  however, 
that  the  upper  third  of  the  thigh  and  buttock, 
hip  and  pelvis  will  all  be  covered.  Between 
layers  of  these  bandages  longitudinal  strips  of 
tyi  or  sheet-iron,  half  an  inch  wide,  may  be 
inserted  to  give  additional  strength.  In  the 
same  way,  any  metal  splint  employed  should 
be  inserted  between  the  strips  of  bandage. 

Plastcr-of-Paris  Jacket. — The  patient,  wearing 
a  closely-fitting  undershirt,  is  placed  in  a  posi- 
tion tending  more  or  less  to  correct  the  de- 
formity of  the  spine ;  if  by  suspension,  as 
shown  in  Fig.  97,  the  hips  must  be  steadied 
by  an  assistant  during  the  application  of  the 
plaster  bandages,  which  are  begun  immedi- 
ately upon  the  undershirt  and  are  carried 
from  a  point  just  below  the  crests  of  the  ilia 
to  the  level  of  the  axillae.  From  three  to  six 
rollers  are  usually  required  to  give  sufficient 
firmness,  when  the  whole  is  covered  with  a 

smooth-spread  layer  of  plaster-cream. 

146 


PLASTER-OF-PARIS  JACKET 


FIG.  97. 


Suspension  apparatus  for  the  applicaticn  of  a  plaster-of-Paris  jacket. 


THE   ROLLER   BANDAGE 

The  dressing  is  applied  in  a  similar  manner 
if  some  other  posture  than  that  of  suspension 
is  used.  Fig.  98  represents  the  method  of 
retaining  the  spine  in  a  more  or  less  corrected 
position  by  the  use  of  a  hammock.  Such  an 


Hammock  for  the  application  of  a  plaster-of- Paris  bandage. 

apparatus  may  be  made  as  an  ordinary  ham- 
mock with  a  strip  of  muslin  two  yards  long 
and  a  yard  wide,  at  the  ends  of  which  are  sewn 
broad  hems.  Into  these  hems  at  either  end  is 

148 


THE   REMOVAL   OF   FIXED    DRESSINGS 

inserted  a  broomstick,  or  the  hammock  may 
be  stretched  from  the  head  to  the  foot  of  the 
bedstead.  The  patient  lies  in  the  position 
which  best  corrects  the  deformity,  and  the 
hammock  is  made  to  sag  to  a  degree  which  is 
found  by  experiment  to  give  the  best  result. 
Two  holes  are  cut  in  it,  through  which  the 
patient's  legs  are  thrust,  and  the  bandages 
are  then  applied.  They  include  in  their  turns 
the  hammock  as  well  as  the  undershirt ;  the 
former  after  the  plaster  has  set  being  cut  off 
with  scissors  at  the  upper  and  lower  edges  of 
the  dressing. 

The  Removal  of  Fixed  Dressings. — The  pre- 
liminary steps  to  facilitate  the  ready  removal 
of  fixed  dressings  are  often  taken  when  the 
dressing  is  being  applied.  A  strip  of  lead 
tape  placed  upon  the  limb,  the  length  the 
dressing  is  planned  to  be,  next  to  the  skin, 
protects  the  latter  from  th  3  point  of  a  pen- 
knife which  may  be  used  to  make  a  long  sec- 
tion in  the  dressing  immediately  after  the 
plaster  has  set.  The  lead  tape  is  then  with- 

149 


THE    ROLLER   BANDAGE 

drawn.  Some  device,  however,  which  leaves 
in  the  dressing  a  hollow  longitudinal  ridge  best 
prepares  it  for  easy  removal.  A  convenient 
device  for  this  purpose  consists  of  a  T-shaped 
rubber  strip  provided  at  one  end  with  a  knob, 
Fig.  99,  and  so  formed  that  when  it  is  placed 

FIG.  99. 


'4*5* 

T-shaped  rubber  strip. 

upon  a  part  prior  to  the  application  of  a  fixed 
dressing,  it  will,  on  withdrawal,  as  soon  as  the 
dressing  has  set,  leave  behind  it  in  the  latter  a 
hollow  longitudinal  ridge.  This  may  be  readily 
divided  by  a  knife  or  plaster  shears  at  any  time 
it  is  desired  to  remove  the  dressing,  and,  a 

150 


THE   REMOVAL   OF    FIXED    DRESSINGS 

clean,  straight  cut  being  thus  made,  the  splint 
will  be  in  a  suitable  condition  to  reapply  if 
necessary.  As  applied  to  the  part,  the  strip 
presents  on  cross-section  the  form  of  an  in- 
verted T ;  and  although  it  increases  the  circum- 
ference of  the  limb  a  fraction  of  an  inch,  it  does 
not  affect  the  proper  tension  of  the  dressing. 
When  a  hinge  in  the  dressing  is  required,  two 
strips  are  applied,  the  ridge  formed  by  the 
one  in  front  being  cut,  while  that  behind 
makes  the  joint.  If  the  strip  has  to  travel 
over  a  very  sharp  curve,  it  should  be  wrapped 
in  wax-paper  in  order  to  lessen  friction  on 
withdrawal.  The  strip  is  placed  upon  the 
limb  after  the  initial  flannel  bandage  has  been 
applied,  and  is  held  in  position  until  the  turns 
of  the  plaster  bandage  themselves  retain  it. 
After  the  dressing  has  set,  traction  upon  the 
strip  easily  withdraws  it,  because  its  thickness 
is  diminished  by  stretching.  If  this  apparatus 
is  not  at  hand,  a  piece  of  rope  covered  with 
wax-paper  may  be  improvised  for  the  purpose. 
Whether  such  a  hollow  ridge  has  been  made 


THE    ROLLER   BANDAGE 

in  the  dressing  or  not,  either  of  the  following 
instruments  may  be  used  to  cut  through  it. 

Reed's  cutter  is  perhaps  the  most  generally 
useful  device  for  cutting  plaster  dressings. 
It  is  shown  in  Fig.  100.  With  it  a  clean  cut 
is  easily  and  rapidly  made  by  the  upper  blade, 
which  has  a  rotary  movement,  and  is  pre- 

FlG.    IOO. 


Reed's  cutter. 


vented  from  slipping  by  the  serrations  on  its 
anterior  edge. 

Van  Brun's  cutter  (Fig.  101)  is  a  powerful  in- 
strument, but  the  leverage  it  exerts  is  liable 
to  be  too  great  for  the  strength  of  the  lower 
blade.  Short  cuts  at  a  time  must  therefore  be 

made  with  it. 

152 


THE    REMOVAL   OF   FIXED    DRESSINGS 


FIG.   101. 


FIG.  102, 


Van  Brun's  cutter. 


Plaster  shears. 


»53 


THE    ROLLER   BANDAGE 

The  shears  shown  in  Fig.  102  will  cut 
through  a  thin  dressing,  but  are  not  adapted 
either  by  their  power  or  their  mode  of  action 
for  section  of  heavy  dressings. 

Darrach's  cutter,  shown  in  Fig.  103,  is  an 

FIG.  103. 


Darrach's  cutter. 


ingenious  device  which  operates  by  the  action 
of  a  rachet  upon  the  cutter. 

Pearson's  circular  saw  is  shown  in  Fig.  104. 
It,    at   times,   works   admirably,   and   slightly 


THE   REMOVAL    OF   FIXED    DRESSINGS 

modified,   so   that  its  handle  would  draw  in 
line  with  the  saw  instead  of  to  one  side  of 

FIG.  104. 


Pearson's  circular  saw. 


it,  it   might   be   made  a  most    useful   instru- 


ment. 


FIG.  105. 


Saw. 


With  the  saw  shown  in  Fig.  105  any  plaster 
dressing  may  be  removed,  but  its  work  is  slow 

'55 


THE   ROLLER   BANDAGE. 

and  laborious.  It  is,  however,  useful  at  times 
in  conjunction  with  one  of  the  various  cutters. 
A  heavy  pruning-knife  with  the  concavity 
on  the  edge  is  also  useful ;  and  if  it  is  made 
to  cut  from  within  outwards,  may  be  manipu- 
lated without  risk  of  wounding  the  skin. 


156 


Index. 


PAGE 

Anterior  figure-of-eight  bandage  of  the  chest 88 

Appliances  for  the  removal  of  fixed  dressings 149 

Application  of  fixed  dressings 139 

of  the  roller  bandage 20 

Ascending  spica  bandage  of  the  groin 97 

of  the  shoulder 69 

of  the  thumb 81 

Bandages,  anterior  figure-of-eight,  of  the  chest 88 

ascending  spica,  of  the  groin 97 

of  the  shoulder 69 

of  the  thumb 81 

Barton's   31 

circular 26 

complete  of  the  foot 113 

crossed  of  the  jaw 38 

demi-gauntlet   85 

Desault's    51 

double-headed  recurrent,  of  the  scalp 42 

figure-of-eight    28 

of  the  chest 88 

of  the  elbow 79 

of  the  eye 44 

of  the  knee 107 

of  the  neck  and  axilla 67 

gauntlet    83 

Gibson's   34 

Hunter's  V 46 

incomplete  of  the  foot in 

knotted  49 

157 


INDEX 

PAGE 

Bandages,   oblique 27 

occipito- facial     36 

of  the  head 29 

of  the  lower  extremity 97 

plaster-of- Paris 137 

posterior  figure-of-eight  of  the  chest 90 

recurrent    21 

of  the  scalp 40 

special    26 

spica 27 

of  the  breast 91 

of  the  foot 109 

of  the  groin 97 

of  the  lower  extremities 97 

of  the  shoulder 69 

of  the  thumb 81 

spiral 26 

of  the  chest 87 

reversed   28 

of  the  lower  extremity. 116 

of  the  upper  extremity. 74 

T- 119 

Velpeau's  63 

White's  head  and  neck 48 

Barton's   bandage '. 31 

Binders    131 

Circular  bandage 26 

Complete  bandage  of  the  foot 113 

Darrach's   plaster-cutter 155 

Demi-gauntlet  bandage  of  the  hand 85 

Desault's    dressing 51 

modification  of,  by  author 61 

Descending  spica  bandage  of  the  groin 100 

of  the  shoulder 72 

of  the  thumb 82 

Double  figure-of-eight  bandage  of  the  eye 45 

I58 


INDEX 

PAGE 

Double-headed  recurrent  bandage  of  the  scalp 41 

Double  roller  bandage 19 

spica  bandage  of  the  breast 94 

of  the  groin 102 

Elbow,  figure-of-eight  bandage  of  the 79 

Figure-of-eight  bandage 28 

of  the  chest 88 

of  the  elbow 79 

of  the  eye 44 

of  the  knee 107 

of  the  neck  and  axilla 67 

Fix,   to 20 

Fixed  dressings,  application  of,  to  the  leg 139 

removal    of 149 

Foot,  complete  bandage  of  the 113 

incomplete  bandage  of  the in 

spica  bandage  of  the 109 

Gauntlet  bandage  of  the  hand 83 

Gibson's    bandage 34 

Groin,  double  ascending  spica  bandage  of  the 102 

descending  spica  bandage  of  the 105 

single  ascending  spica  bandage  of  the 97 

descending  spica  bandage  of  the 100 

Hammock  for  the  application  of  plaster-of-Paris  jacket.  .  148 

Hand,  demi-gauntlet  bandage  of  the 85 

gauntlet  bandage  of  the 83 

rolling  bandages  by 10 

Head,  bandages  of  the 29 

Hunter's  V  bandage §  46 

Incomplete  bandaging,  dangers  of 16 

bandage  of  the  foot in 

Key  for  rolling  bandages 1 1 

Knee,  figure-of-eight  bandage  of  the 107 

Knots    134 

Knotted  bandage  of  the  head 49 

Lower  extremity,  bandages  of  the 97 

159 


INDEX 

PAGE 

Machine,  bandage 13 

Oblique  bandage 27 

Occipito-facial    bandage 36 

Overlap,  to 21 

Parts  of  the  roller  bandage 19 

Pearson's  plaster-saw 155 

Plaster-cutters  and  shears 152 

Plaster-of- Paris  bandages 137 

application  of 138 

method  of  making  a  window  in 143 

removal  of 149 

jacket 146 

hammock  for  application  of 148 

Posterior  figure-of-eight  bandage  of  the  chest 90 

Recur,  to 21 

Recurrent  bandage 21 

Recurrent  bandage  of  the  scalp 40 

Reed's  plaster-cutter 152 

Remove,  to,  a  roller  bandage 26 

Repeat,  to 20 

Reverse,  descending  to 24 

Reverse,  to 22 

Roller   bandage 9 

definition   of 9 

materials    for 9 

method  of  application  of 15,  20 

method  of  rolling 10 

parts   of 19 

uses  of 14 

Scalp,  recurrent  bandage  of  the 40 

Secure,   to 25 

Single  roller  bandage 19 

spica  of  the  breast 91 

of  the  groin 97 

Size  of  bandages 13 

Slings   124 

160 


INDEX 

PAGE 

Slings,  four-tailed 127 

four-tailed  of  the  chin 130 

four-tailed  of  the  ear 129 

four-tailed  of  the  eye 128 

Special  bandages 26 

Spica  bandage 27 

of  the  breast 91 

of  the  foot 109 

of  the  groin,  double  ascending 102 

descending    105 

single  ascending 97 

descending 100 

of  the  shoulder,  ascending 69 

descending 72 

of  the  thumb,  ascending 81 

descending 82 

Spiral  bandage . . . ! 26 

of  the  chest 87 

reversed   28 

of  the  lower  extremity 116 

of  the  upper  extremity 74 

T-bandages 119 

of  the  chest 121 

of  the  ear 123 

of  the  pubis 121 

Tension  of  the  roller  bandage 14 

influenced  by  the  application  of  splints 16 

by  a  change  in  the  position  of  the  part 18 

by  habit 18 

by  incomplete  bandaging 16 

by  the  character  of  the  dressing  beneath 16 

by  the  circumference  of  the  part  bandaged 15 

by  the  flexion  and  extension  of  the  joints 17 

by  the  number  of  turns 17 

by  the  shrinkage  of  the  muslin 17 

by  the  situation j8, 

«  161 


INDEX 

PAGE 
Tension  influenced  by  the  texture  and  condition  of  the 

tissues  18 

Trunk,  bandages  of 87 

Upper  extremity,  bandages  of  the 51 

Uses  of  the  roller  bandage 14 

Van  Brun's  plaster-cutter 152 

Varieties  of  roller  bandages 19 

Velpeau's  bandage 63 

White's  head  and  neck  bandage 48 


THE    END 


162 


Date  Due 


CAT.    NO      ?3    233  PRINTED    IN    U.S.A. 


wo  167 

H?96r 
1911 

Hopkins,  William  Barton. 
The  roller  bandage 


Hopkins,  William  Barton. 
The  roller  bandage 


wo  167 

H796r 
1911 


MEDICAL  SCIENCES  LIBRARY 

UNIVERSITY  OF  CALIFORNIA,  IRVINE 

IRVINE,  CALIFORNIA  92664 


